冠動脈硬化の様式とリポ蛋白(a)

Abstract

The arteriographic features of patients with ischemic heart disease are diverse, ranging from normal coronary artery to severe multivessel disease. Although many investigators have considered lipoprotein (a) [Lp (a)] as an independent risk factor for coronary heart disease, the relationship between Lp (a) and diversing arteriographic feature of coronary atherosclerosis has not been fully resolved. In this study, we tried to analyze the relationship between Lp (a) and the arteriographic feature of coronary atherosclerosis.Subjects are 230 patients with ischemic heart disease who underwent coronary arteriography. Patients were divided into four groups according to the coronary arteriographic findings (Group I: near normal group, Group II: diffuse minor group, Group III: solitary tight group, Group IV: diffuse tight group).The following 16 variables were selected. The variables analyzed were age, sex, hypertension, diabetes mellitus, smoking, uric acid, obesity, total cholesterol, triglyceride, HDL-cholesterol, apolipoprotein A1, apolipoprotein B, apolipoprotein E, LDLC/HDLC, apo B/A1, and Lp (a). The relationship between these variables and the coronary arteriographic findings was analyzed by multivariate analysis.Serum Lp (a) levels in each group was 15.9±9.3mg/dl in Group I, 23.6±18.7mg/dl in Group II, 10.8±7.8mg/dl in Group III, and 26.4±18.3mg/dl in Group IV, respectively. Patients in Groups II and IV revealed significantly higher serum Lp (a) levels than Groups I and III (p<0.05).By logistic regression analysis, diabetes mellitus, age, LDL/HDLC and Lp (a) were determined as correlating factors in this order for Groups II and IV, i. e., groups with diffuse coronary atherosclerosis.So, Lp (a) was considered to be one of the independent risk factors for the pathogenesis of diffuse coronary atherosclerosis. The stronger Lp (a) contributes to the pathogenesis of coronary atherosclerosis, the more prevalent and progressive the atherosclerosis can originate. Therefore, Lp (a) is one of the valuable parameters for the detection of the expansion and the severity of coronary atherosclerosis.