Gender, clinical and instrumental parallels of Lp(a) levels in patients with very high cardiovascular risk

Main Article Content

O. I. Mitchenko
Y. O. Bila
D. O. Bilyi

Abstract

In recent years it has been established that elevated levels of Lp(a) are an independent genetic risk factor for the development of atherosclerotic cardiovascular diseases and aortic stenosis, however, issues of gender and age characteristics remain controversial.
The aim of study was to analyze the gender characteristics of the relationship between Lp(a) levels and atherogenic changes in the lipid spectrum of the blood, clinical and instrumental characteristics, taking into account damage to the aortic valve and the results of coronary angiography in patients with stable coronary heart disease. 
Materials and methods. The 106 patients with chronic coronary heart disease (CAD) were examined. The average age of the subjects was 55.00±1.0 years (95% CI 51.11-58.89), among them: 78 men and 28 women.
The entire cohort of patients was divided depending on the Lp(a) levels: 1group (n=58) with a Lp(a) level less than 50 mg/dl; 2 group (n=20) with Lp(a) level 50-100 mg/dl; 3 group (n=8) with Lp(a) level 101-150 mg/dl and 4 group (n=20) with Lp(a) level more than 150 mg/dl.
Research methods included: 1. General clinical examination; 2. Laboratory characteristics of lipid (with determination of Lp(a)) and carbohydrate metabolism, as well as standard biochemical parameters; 3. Instrumental examination (electrocardiography, echocardiography, ultrasound peripheral vessels examination, coronary angiography); 4. Mathematical and statistical processing of the results obtained.
Results and conclusions. In patients with CAD verified by clinical-instrumental and coronary angiographic criteria, it is noted that Lp(a) levels in women are on average significantly higher (P< 0.05) than in men and increase with the onset of menopause.
Close correlations have not been recorded between Lp(a) in mg/dL and total cholesterol, LDL cholesterol and non-HDL cholesterol, as well as the concentrations of glucose, glycosylated hemoglobin, serum creatinine, and the concentration of thyroid-stimulating hormone (TSH).
Determined that in patients with documented atherosclerotic lesions of the coronary arteries against the Lp(a) levels above 100 mg/dl, there is a greater need for coronary revascularization. A close relationship is observed between the increase in Lp(a) levels and the percentage of detection of aortic stenosis, which confirms the pathogenetic role of this lipoprotein in the formation of this acquired aortic valve disease.

Article Details

Keywords:

Lipoprotein(a), coronary heart disease, lipids, revascularization, aortic stenosis.

References

Kronenberg F, Mora S, Stroes ESG, Ference BA, Arsenault BJ, Berglund L, Dweck MR, Koschinsky M, Lambert G, Mach F, McNeal CJ, Moriarty PM, Natarajan P, Nordestgaard BG, Parhofer KG, Virani SS, von Eckardstein A, Watts GF, Stock JK, Ray KK, Tokgözoğlu LS, Catapano AL. Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. Eur Heart J. 2022 Oct 14;43(39):3925-46. https://doi.org/10.1093/eurheartj/ehac361.

Cegla J, France M, Marcovina SM, Neely RDG. Lp(a): When and how to measure it. Ann Clin Biochem. 2021 Jan;58(1):16-21. https://doi.org/10.1177/0004563220968473.

Andreja Rehberger Likozara, Mark Zavrtanikb, Miran Sebestjen, Lipoprotein(a) in atherosclerosis: from pathophysiology to clinical relevance and treatment options. Ann Med. 2020 Aug;52(5):162-77.https://doi.org/10.1080/07853890.2020.1775287.

Nordestgaard BG, Chapman JM, Ray K, Borén J, Andreotti F, Watts GF, Ginsberg H, Amarenco P, Catapano A, Descamps OS, Fisher E, Kovanen PT, Kuivenhoven JA, Lesnik P, Masana L, Reiner Z, Taskinen M-R, Tokgözoglu L, Tybjærg-Hansen A for the European Atherosclerosis Society Consensus Panel. Lipoprotein(a) as a cardiovascular risk factor: current status. Eur Heart J. 2010;31: 2844-53. https://doi.org/10.1093/eurheartj/ehq386.

Albert Youngwoo Jang, Seung Hwan Han, Il Suk Sohn, Pyung Chun Oh, Kwang Kon Koh. Lipoprotein(a) and Cardiovascular Diseases. Circ J. 2020 May 25;84(6):867-74. https://doi.org/10.1253/circj.CJ-20-0051.

Finneran Phoebe, Akhil Pampana, Sumeet A. Khetarpal, Mark Trinder, Aniruddh P. Patel, Kaavya Paruchuri, Krishna Aragam, Gina M. Peloso, Pradeep Natarajan. Lipoprotein(a) and Coronary Artery Disease Risk Without a Family History of Heart Disease. J Am Heart Assoc. 2021 Feb;10(5):e017470. https://doi.org/10.1161/JAHA.120.017470.

Shai I, Rimm EB, Hankinson SE, Cannuscio C, Curhan G, Manson JAE, Rifai N, Stampfer MJ, Jing Ma. Lipoprotein (a) and coronary heart disease among women: beyond a cholesterol carrier? Eur Heart J. 2005 Aug;26(16):1633-9. https://doi.org/10.1093/eurheartj/ehi222.

Cook NR, Mora S, Ridker PM. Lipoprotein(a) and Cardiovascular Risk Prediction Among Women J Am Coll Cardiol. 2018 Jul 17;72(3):287-96. https://doi.org/10.1016/j.jacc.2018.04.060.

Rosenson RS, Marcovina SM. Refining Lipoprotein(a) Associated Cardiovascular Risk in Women. J Am Coll Cardiol. 2018 Jul 17;72(3):297-9. https://doi.org/10.1016/j.jacc.2018.05.011.

Simony SB, Mortensen MB, Langsted A, Afzal S, Kamstrup PR, Nordestgaard BG. Sex differences of lipoprotein(a) levels and associated risk of morbidity and mortality by age: The Copenhagen General Population Study. Atherosclerosis. 2022 Aug:355:76-82. https://doi.org/10.1016/j.atherosclerosis.2022.06.1023.

Lazoryshynets VV, Kovalenko VM, Potashev SV, Fedkiv SV, Rudenko AV, Vitovskiy RM, Sychov OS, Rudenko SA, Ivaniv YA, Krikunov OA, Mazur OA, Hrubyak LM, Rusnak AO, Osovska NY, Deyak SI, Verich NM, Beshlyaga VM. [Cardiac Chamber Quantification by Echocardiography in Adults: Recommendations from the Association of Cardiovascular Surgeons of Ukraine and Ukrainian Society of Cardiology]. Ukrainian Journal of Cardiovascular Surgery. 2020;4(41):96-117. https://doi.org/10.30702/ujcvs/20.4112/096-117.16.12.22020. Ukrainian

Rudenko SA, Kaschenko YV, Klimenko LA, Osipenko NS, Rudenko AV, Yuvchyk OV. Preoperative Factors Influencing the Results of Coronary Artery Bypass Grafting with Reduced Left Ventricular Myocardial Contractility. Ukrainian Journal of Cardiovascular Surgery. 2020;3(40):38-42. https://doi.org/10.30702/ujcvs/20.4009/044038-042/163.

Rachele Manzo, Federica Ilardi, Dalila Nappa. Echocardiographic Evaluation of Aortic Stenosis: A Comprehensive Review Diagnostics (Basel). 2023 Jul 29;13(15):2527. https://doi.org/10.3390/diagnostics13152527.

Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W; ESC/EACTS Scientific Document Group. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2022 Feb 12;43(7):561-632. https://doi.org/10.1093/eurheartj/ehab395.

Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin III JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O’Gara PT, Rigolin VH, Sundt III TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021 Feb 2;143(5):e35-e71. https://doi.org/10.1161/CIR.0000000000000932.

Reyes-Soffer G, Ginsberg HN, Berglund L, Duell PB, Heffron SP, Kamstrup PR, Lloyd-Jones DM, Marcovina SM, Yeang C, Koschinsky ML. Lipoprotein(a): A Genetically Determined, Causal, and Prevalent Risk Factor for Atherosclerotic Cardiovascular Disease: A Scientific Statement From the American Heart Association. Arterioscler Thromb Vasc Biol 2022 Jan;42(1):e48-e60. https://doi.org/10.1161/ATV.0000000000000147.

Ghavami M, Abdshah A, Esteghamati S, Hafezi-Nejad N, Nakhjavani M, Esteghamati A. Serum lipoprotein(a) and reclassification of coronary heart disease risk; application of prediction in a cross-sectional analysis of an ongoing Iranian cohort. BMC Public Health. 2023 Dec 2;23(1):2402. https://doi.org/10.1186/s12889-023-17332-w.

Catapano AL, Tokgözoğlu L, Banach M, Gazzotti M, Olmastroni E, Casula M, Ray KK, on behalf ofLipid Clinics Network Group. Evaluation of lipoprotein(a) in the prevention and management of atherosclerotic cardiovascular disease: A survey among the Lipid Clinics Network. Atherosclerosis. 2023 Apr:370:5-11. https://doi.org/10.1016/j.atherosclerosis.2023.02.007.