Abstract
Objective:To compare and see the association of serum Lipoprotein (a) levels in younger and older patients suffering from acute coronary syndrome compared to healthy controlsMethods:This case control study was conducted in department of cardiology, King Edward Medical University, Lahore from January to December 2015. Total 180 subjects (90 cases and 90 healthy controls, subdivided in 45 young and old in each group ≤/>45 years of age) were included in the study by non-probability purposive sampling. Patients presenting with acute coronary event and angiographically proven coronary vascular disease were considered cases while those with normal coronaries served as controls. Lp(a) was measured after ten hours fasting. Lp(a) >30 nmol/l) were considered as high. Data were entered and analyzed in SPSS 17. Independent sample t-test was used to compare the mean lipoprotein (a) in cases and controls.Results:The mean age of cases and controls was 48.02 ± 10.90 & 45.89±10.09 years respectively. Lipid profile was similar in both cases and controls except triglycerides that were higher in controls (p=0.024). The mean lipoprotein (a) in cases was 47.03 ± 45.47 and in controls was 29.69±23.10 (p-value 0.001). Mean Lp(a) level was significantly high in cases vs controls in young subjects, (50.15±55.62 vs 25.75±15.84, p= 0.006), while in old ones, difference was not statistically significant (43.92±32.69 vs 33.64±28.22, p= 0.114). The frequency of desirable, borderline high, high, and very high Lp(a) levels in cases was 23(25.6%), 12(13.3%), 27(30.0%) and 28(31.1%), while in controls, it was 26(28.9%), 31(34.4%), 17(18.9%) and 16(17.8%), (p-value 0.003). Chi-Square test showed significant association of high Lp(a) with coronary artery disease in younger cases vs controls (P=0.004) with OR 3.65 but not in older (p-value 0.358).Conclusion:Serum lipoprotein(a) is strongly associated with coronary vascular disease especially in patients younger than 45 years of age despite comparable LDL and HDL between cases and controls, making Lp(a) likely independent risk factor for coronary vascular disease.
Highlights
Coronary vascular disease (CVD) is the major cause of morbidity and mortality and its prevalence is increasing in Pakistan.[1]
We planned our study to evaluate Lp(a) as a cardiovascular risk factor in ≤/>45 years of age patients presenting with first episode of acute coronary syndrome and angiographically normal persons as controls, so as to consider Lp(a) in age stratified strategies to effectively target our highrisk patients with coronary vascular disease
The 30 mg/ dl cutoff of high Lp(a) we used is consistent with recommendation generated by EPIC-Norfolk data that suggests that Lp(a) level between 24-36 mg/dl should be used to estimate risk of coronary artery disease.[12]
Summary
Coronary vascular disease (CVD) is the major cause of morbidity and mortality and its prevalence is increasing in Pakistan.[1] Among all conventional risk factors and lipid, one is lipoprotein(a), originally discovered by Berg in 1963, a variant of LDL whose amount and characteristics are genetically determined. It contains cholesterolrich LDL particle along with apolipoprotein B100 and apolipoprotein(a). We planned our study to evaluate Lp(a) as a cardiovascular risk factor in ≤/>45 years of age patients presenting with first episode of acute coronary syndrome and angiographically normal persons as controls, so as to consider Lp(a) in age stratified strategies to effectively target our highrisk patients with coronary vascular disease
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