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Tselmin, S.* ; Julius, U.* ; Müller, G.* ; Fischer, S.* ; Bornstein, S.R.*

Cardiovascular events in patients with increased lipoprotein (a) - retrospective data analysis in an outpatient department of lipid disorders.

Atherosclerosis 10, 79-84 (2009)

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INTRODUCTION: The role of lipoprotein (a) (Lp(a)) in atherogenesis has been previously demonstrated in several trials reporting various and sometimes contradictory findings. Our retrospective study analyzed the incidence of cardiovascular events in patients with Lp(a) plasma level of more than 250 mg/l, which has been defined as a threshold in previous publications. METHODS: The files of 303 patients with Lp(a) of more than 250 mg/l were divided into 5 groups categorized by Lp(a) level increase and reviewed regarding age, sex, BMI, dyslipidemias, arterial hypertension, diabetes mellitus, family history of cardiovascular events, fatty liver and incidence of vascular events in coronaries, carotids and lower extremities. RESULTS: No significant differences were observed with respect to sex, age, BMI, dyslipidemias, diabetes mellitus, arterial hypertension and hepatic steatosis. The likely occurrence of at least one event was 2.77 times more in the fourth (Lp(a) 1235 +/- 82 mg/l) and 6.2 times more in the fifth (Lp(a) 2068 +/- 471 mg/l) than in the first group (Lp(a) 322 +/- 48 mg/l). The 5 groups differed with respect to average "events per patient" (p < 0.001). The magnitude of increased Lp (a) exceeded that of other risk factors. CONCLUSION: A substantially (more than 1100 mg/l) elevated Lp(a) plasma level seems to be an important predictor for the occurrence of cardiovascular events. It makes sense in clinical practice to consider patients exhibiting this elevation as having a high cardiovascular risk. In case of progression of atherosclerotic complications the patients should be assigned for lipid apheresis.

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