Age-related contribution of Lp(a) with coronary artery calcification in patients with acute coronary syndrome: a potential role of metabolic disorder in calcified plaque.
Lp(a) and coronary artery calcification (CAC) have recently been reported as predictors of plaque instability, but this is surrounded by much controversy. We investigated the influence of Lp(a) and CAC compared other acute coronary syndrome (ACS) risk factors. 698 patients diagnosed with at least minimal coronary artery obstructive disease from a coronary angiography were randomly selected using SPSS. Lp(a), other lipid profiles and past histories were checked, and CAC semi quantitatively graded on stored fluoroscopic images. The prevalence of CAC was significantly higher in the ACS than the non-ACS group (38.0% vs. 29.9%, p=0.026). The serum level of Lp(a) (26.89 +/- 30.64 vs. 20.85 +/- 21.63, p < 0.01) and prevalence of positive Lp(a) (> 35 mg/dl) was higher in the ACS group (24% vs. 15.7%, p < 0.01). The risk of ACS was higher in the patients with both CAC and elevated an Lp(a) than in those with only one (OR: 2.16, p=0.009, 95% CI; 1.213 - 3.843 vs. OR: 1.79, p < 0.001, 95% CI; 1.300 - 2.456). The risk of ACS was increased 1.451 times (p=0.040, 95% CI; 1.071- 2.071) in patients with CAC and 1.648 times (p=0.014, 95% CI; 1.107- 2.455) in patients with a Lp(a) > 35 mg/dl. In the younger patients (< 60 years), the Lp(a), but not the CAC, was an independent risk factor for ACS (OR=2.248, p=0.005, 95% CI; 1.281-3.943). In the older patients (> 60 years), CAC, but not the Lp(a), was an independent risk factor (OR=1.775, p=0.021, 95% CI; 1.090 - 2.890). Both the Lp(a) and CAC were risk factors for ACS, and they had a synergistic effect on its development. In the younger Lp(a), and the older CAC, was the more potent risk factor for ACS, respectively.
Ryu
Sung Kee
SK
Department of Internal Medicine, Yonsei University College of Medicine, 146-92, Dogok-dong, Kangnam-gu, Seoul 135-270, Korea.
Hong
Bum Kee
BK
Kwon
Hyuck Moon
HM
Kim
Dong Soo
DS
Chung
Wook Jin
WJ
Park
Byoung Eun
BE
Kim
Dong-Yeon
DY
Cho
Yun-Hyeong
YH
Yoon
Se Jung
SJ
Yoon
Young Won
YW
Cho
Seung-Yun
SY
Kim
Hyun Seung
HS
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000375:Aging / Q000097:blood*; D002114:Calcinosis / Q000097:blood / Q000150:complications*; D003324:Coronary Artery Disease / Q000097:blood / Q000209:etiology*; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D006801:Humans; D017270:Lipoprotein(a) / Q000097:blood*; D008297:Male; D008659:Metabolic Diseases / Q000150:complications; D008875:Middle Aged; D012307:Risk Factors; D013577:Syndrome
D017270:Lipoprotein(a)