Article Text

other Versions

PDF
A high lipoprotein(a) level confers approximately equal positive effects on coronary atherosclerosis and myocardial infarction: a path analysis using a large number of autopsy cases
  1. Motoji Sawabe (sawabe{at}tmig.or.jp)
  1. Tokyo Metropolitan Geriatric Hospital, Japan
    1. Noriko Tanaka
    1. Harvard School of Public Health, United States
      1. Ken-ichi Nakahara
      1. Nagasaki Medical Center, Japan
        1. Akihiko Hamamatsu
        1. Tokyo Metropolitan Geriatric Hospital, Japan
          1. Kouji Chida
          1. Tokyo Metropolitan Geriatric Hospital, Japan
            1. Tomio Arai
            1. Tokyo Metropolitan Geriatric Hospital, Japan
              1. Kazumasa Harada
              1. Tokyo Metropolitan Geriatric Hospital, Japan
                1. Takashi Inamatsu
                1. Tokyo Metropolitan Geriatric Hospital, Japan
                  1. Toshio Ozawa
                  1. Tokyo Metropolitan Geriatric Hospital, Japan
                    1. Makiko Mieno Naka
                    1. Jichi Medical University, Japan
                      1. Satoru Matsushita
                      1. Tokyo Metropolitan Geriatric Hospital, Japan

                        Abstract

                        Objective: To investigate whether hyper-lipoproteinemia(a) [Lp(a)] promotes coronary atherosclerosis, acute thrombosis resulting in myocardial infarction (MI), or both.

                        Design: Retrospective chart review.

                        Setting: A community-based general geriatric hospital.

                        Patients: 1,062 consecutive autopsy cases (609 men, 453 women). The mean age at the time of death was 80 years.

                        Main outcome measures: A semiquantitative evaluation of the coronary stenosis on cut sections and pathological definition of MI. Lp(a) levels of fresh serum taken antemortem, measured by a latex-enhanced turbidimetric immunoassay.

                        Results: The prevalence of severe coronary stenosis and pathological MI increased linearly with increasing Lp(a) levels with no apparent threshold. The odds ratios (95% C.I.) of hyper-Lp(a) [2.99 (1.70 - 5.28) for 200 - 299 mg/L and 3.25 (1.90 - 5.54) for > 300 mg/L] for severe coronary stenosis were larger than those of hypertension [2.61 (1.88 - 3.63)], diabetes mellitus [2.09 (1.41 - 3.11)], and hypercholesterolaemia [2.05 (1.31 - 3.21)]. The severe coronary sclerosis was much stronger risk of MI [6.28 (4.33 - 9.11)] than hyper-Lp(a), hypertension, and diabetes mellitus. A path analysis showed that the Lp(a) levels affected both coronary sclerosis and MI, with path coefficients of 0.15 and 0.07 (direct effect), respectively. In cases with severe coronary sclerosis, Lp(a) affected only MI (0.15).

                        Conclusions: Lp(a) levels have distinct effects on coronary sclerosis and MI, with about half of the overall effect on MI being via coronary sclerosis. This result supports the prothrombotic and a probable proinflammatory role of Lp(a) in coronary events.

                        Statistics from Altmetric.com

                        Request permissions

                        If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.