Lipoprotein(a) level associates with coronary artery disease rather than carotid lesions in patients with familial hypercholesterolemia.

Abstract

Lipoprotein(a) [Lp(a)] level is a novel risk factor for atherosclerotic cardiovascular disease in patients with familial hypercholesterolemia (FH), while its impact on the different sites of arteries remains undetermined. We aim to examine the associations of Lp(a) levels with coronary and carotid atherosclerosis in patients with heterozygous FH (HeFH). A total of 148 patients with HeFH who have received carotid ultrasonography and coronary angiography due to chest pain were enrolled. Plasma Lp(a) was measured using immunoturbidimetric method. Finally, the associations between Lp(a) and coronary as well as carotid lesions were evaluated. Patients with Lp(a)≥300mg/L had similar carotid intima-media thickness (IMT, 0.782±0.16mm vs 0.798±0.18mm, P=.579) and plaque prevalence (66.7% vs 65%, P=.833) compared to those with Lp(a)<300mg/L, but had a higher prevalence of coronary artery disease (CAD, 69.7% vs 50.0%, P=.016) and higher Gensini score (GS, median 27 vs 3, P=.006). Moreover, no correlations were found between carotid mean IMT with either Lp(a) level or Lp(a) year score, while positive relation of Lp(a) with GS did. Multivariate regression analysis revealed that Lp(a), Lp(a) year score, and Lp(a)≥300g/L were all independent predictors for the presence of CAD (OR=4.99, P=.007; OR=4.73, P=.009; OR=4.46, P=.006, respectively) but not for carotid plaques. This study suggested that Lp(a) level was associated with the presence and severity of CAD but not with carotid atherosclerosis in patients with HeFH.