750-4 The Influence of Lipoprotein(a) Levels on the Angiograpic Course of Coronary Atherosclerosis in Patients with High and Low LDL-C

Abstract

Previous reports have indicated that a high level of Lp(a) is an independent risk factor for coronary artery disease. Data from angiographic regression trials suggest that the adverse effect of high Lp(a) can be ameliorated by lowering LDL-C. Patients with mild coronary atherosclerosis and with total cholesterol of 6.43 ± 0.75 mmol/l, LDL-C 4.40 ± 0.69 mmol/l, and LP(a) 25.4 ± 27.6 mg/dl were treated with placebo (N = 167) or simvastatin 20 mg daily (N = 178). Quantitative Coronary Angiography was performed at oand 4 years. Both the changes in mean lumen diameter (diffuse coronary atherosclerosis), and minimum lumen diameter and diameter stenosis (focal coronary atherosclerosis) were assessed. Angiographic changes were stratified by Lp(a) level and by LDL-C level during the trial. Simvastatin lowered TC by 23%, LDL-C by 31%, Lp(a) was not influenced. The angiographic changes over 4 years were as follows: LDL-C < 3.5 ≥3.5 mmol/l P Mininum Diameter (mm): Lp(a)< 35 mg/dl -0.05 ± 0.24 -0.15 ± 0.27 0.005 ≥35 mg/dl -001 ± 0.24 -0.05 ± 0.25 ns Diameter stenosis (%): Lp(a) < 35 mg/dl 0.5 ± 7.8 4.1 ± 9.5 0.001 ≥ 35 mg/dl 0.5 ± 6.7 2.8 ± 7.9 ns Mean Lumen Diameter (mm): Lp(a)<35 mg/dl -0.05 ± 0.24 -0.09 ± 0.24 ns > 35 mg/dl 0.01 ± 0.25 -0.01 ± 0.24 ns our findings contrast with previous reports and show that high Lp(a) is associated with more progression of focal atherosclerosis (but not diffuse) when LDL-C is low. Lowering LDL-C was more beneficial when Lp(a) was low.