Lp(a) Lipoprotein Is an Independent, Discriminating Risk Factor for Premature Peripheral Atherosclerosis Among White Men

doi:10.1001/archinte.1994.00420070129015

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Vol. 154 No. 7, 11 April 1994

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Lp(a) Lipoprotein Is an Independent, Discriminating Risk Factor for Premature Peripheral Atherosclerosis Among White Men

R. James Valentine, MD; Paul A. Grayburn, MD; Gloria L. Vega, PhD; Scott M. Grundy, MD, PhD

Arch Intern Med. 1994;154(7):801-806.

Abstract

Background
Elevated plasma levels of Lp(a) lipoprotein have been linkedto the development of premature atherosclerosis in the coronarycirculation (coronary artery disease [CAD]). Although Lp(a)lipoprotein has been implicated as a risk factor for prematureatherosclerosis in other locations, the patient populationsdescribed were not carefully screened for the coexistence ofpremature CAD. The purpose of this prospective study was todetermine whether carefully screened patients with prematureperipheral vascular disease (PVD) have elevated plasma levelsof Lp(a) lipoprotein and to test the relative strength of Lp(a)lipoprotein level as a risk factor for premature PVD.

Methods
We studied 55 consecutive white men with premature PVD (onsetat 45 years of age or earlier) presenting to our vascular laboratory.Study subjects were substratified into 17 with PVD only and38 with combined PVD and CAD (PVD + CAD). Two comparison groupsincluded 26 age-matched white men with premature CAD recruitedfrom the Cardiology Service after cardiac catheterization and32 age-matched white male controls recruited from outpatientclinics.

Results
Mean plasma apolipoprotein B-100 levels were higher in the CADgroup than in controls (P=.013). Mean plasma Lp(a) lipoproteinlevels were higher among the 17 patients with PVD only thanamong controls (P=.008). The covariance-adjusted mean Lp(a)lipoprotein levels were higher among all 55 patients with PVDthan among controls (P=.014). Logistic regression analysis demonstratedtwo variables to be significantly related to premature PVD:Lp(a) lipoprotein level greater than 30 mg/dL (odds ratio, 3.9;95% confidence interval, 1.1 to 13.7) and apolipoprotein B levelgreater than 95 mg/dL (odds ratio, 3.2; 95% confidence interval,1.0 to 10.0).

Conclusions
Lp(a) lipoprotein level is an independent, discriminating riskfactor for premature PVD among white men.

(Arch Intern Med. 1994;154:801-806)

Author Affiliations

From the Vascular Surgery Section, Department of Surgery (Dr Valentine); the Cardiology Section, Department of Medicine (Dr Grayburn); and the Center for Human Nutrition, Departments of Clinical Nutrition (Dr Vega) and Medicine (Dr Grundy), Veterans Affairs Medical Center and University of Texas Southwestern Medical Center, Dallas.

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