Dieplinger Benjamin, Lingenhel Arno, Baumgartner Nadja, Poelz Werner, Dieplinger Hans, Haltmayer Meinhard, Kronenberg Florian, Mueller Thomas
Department of Laboratory Medicine, Konventhospital Barmherzige Brueder Linz, Linz, Austria.
Clin Chem. 2007 Jul;53(7):1298-305. doi: 10.1373/clinchem.2007.088013. Epub 2007 May 24.
Increased concentrations of lipoprotein(a) [Lp(a)] have been considered a genetically determined risk factor for coronary artery and cerebrovascular disease. Only 2 small and conflicting studies have investigated the possibility of an association of peripheral arterial disease (PAD) with high serum Lp(a) concentrations and low molecular weight (LMW) phenotypes of apolipoprotein(a) [apo(a)].
We measured serum concentrations of Lp(a) and apo(a) phenotypes in 213 patients with symptomatic PAD and 213 controls matched for sex, age (within 2 years), and presence of diabetes.
Patients with PAD showed significantly higher median serum concentrations of Lp(a) (76 vs 47 mg/L; P = 0.003) and a higher frequency of LMW apo(a) phenotypes (41% vs 26%; P = 0.002) than controls. After adjustment for several potential confounders, increased Lp(a) concentrations (>195 mg/L, i.e., 75th percentile of the entire study sample) and LMW apo(a) phenotypes were significant predictors of PAD, with odds ratios of 3.73 (95% CI 2.08-6.67; P <0.001) and 2.21 (95% CI 1.33-3.67; P = 0.002), respectively.
In this study sample, both increased serum concentrations of Lp(a) and the presence of LMW apo(a) phenotypes were associated with the presence of symptomatic PAD independent of traditional and nontraditional cardiovascular risk factors. Because PAD is considered an indicator of systemic atherosclerotic disease, our results suggest a possible role of Lp(a) as a genetically determined marker for systemic atherosclerosis.
脂蛋白(a)[Lp(a)]浓度升高被认为是冠状动脉和脑血管疾病的遗传决定风险因素。仅有两项小型且结果相互矛盾的研究探讨了外周动脉疾病（PAD）与高血清Lp(a)浓度及载脂蛋白(a)[apo(a)]低分子量（LMW）表型之间存在关联的可能性。
我们测量了213例有症状PAD患者以及213例在性别、年龄（相差2岁以内）和糖尿病存在情况相匹配的对照者的血清Lp(a)浓度和apo(a)表型。
与对照组相比，PAD患者的血清Lp(a)中位数浓度显著更高（76 vs 47 mg/L；P = 0.003），且LMW apo(a)表型的频率更高（41% vs 26%；P = 0.002）。在对多个潜在混杂因素进行校正后，Lp(a)浓度升高（>195 mg/L，即整个研究样本的第75百分位数）和LMW apo(a)表型是PAD的显著预测因素，优势比分别为3.73（95%CI 2.08 - 6.67；P <0.001）和2.21（95%CI 1.33 - 3.67；P = 0.002）。
在本研究样本中，血清Lp(a)浓度升高和LMW apo(a)表型的存在均与有症状PAD的存在相关，且独立于传统和非传统心血管危险因素。由于PAD被视为全身性动脉粥样硬化疾病的一个指标，我们的结果提示Lp(a)可能作为全身性动脉粥样硬化的遗传决定标志物发挥作用。
