title: Lipoprotein(a)-associated atherothrombotic risk in hemodialysis patients.
abstract: BACKGROUND
  Hemodialysis patients show a considerably higher risk of atherothrombotic disease than the general population. We investigated both lipoprotein(a) [Lp(a)] plasma levels and apolipoprotein(a) [apo(a)] phenotypes in relation to occurrence of atherothrombotic events in hemodialysis patients compared with subjects showing a normal kidney function.
  
  
  METHODS
  Lp(a) levels and apo(a) isoforms were determined in 118 hemodialysis patients, including 59 with prior atherothrombotic events, and in 182 subjects with normal creatinine clearance, including 82 who experienced a prior atherothrombotic event.
  
  
  RESULTS
  Lp(a) levels in hemodialysis patients (median; 20 mg/dl) were higher (p < 0.01) than in age- and sex-matched subjects with normal renal function without a history of atherothrombosis (11.3 mg/dl). Among hemodialysis patients, median Lp(a) levels were higher in subjects with than in those without prior atherothrombosis (34 vs. 15 mg/dl, p < 0.05). In hemodialysis patients and in subjects without nephropathy, the percentage of low-molecular-weight apo(a) phenotypes were significantly higher in patients with than in those without a history of prior atherothrombotic events (56.9% vs. 33.9%, p < 0.05; 62.2% vs. 25%, p < 0.00001,respectively). Stepwise regression analysis indicated that the presence of at least one apo(a) isoform of low molecular weight was an independent predictor of atherothrombosis in hemodialysis patients (p < 0.05).
  
  
  CONCLUSIONS
  Elevated Lp(a) plasma levels appear to be associated with atherothrombosis, independent of their origin due to genetic factors or related to the impaired kidney function. Low-molecular-weight apo(a) isoforms are reliable genetic markers of atherothrombosis both in patients with impaired kidney function and in subjects without nephropathy.
authors.affiliation: Molecular Medicine Laboratory, IRCCS San Matteo Hospital, University of Pavia, Pavia, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Emanuele
authors.forename: Luigi Segagni
authors.initials: LS
authors.lastname: Lusignani
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Peros
authors.forename: Giovanni
authors.initials: G
authors.lastname: Montagna
authors.forename: Angela
authors.initials: A
authors.lastname: D'Angelo
authors.forename: Lorenza
authors.initials: L
authors.lastname: Montagna
authors.forename: Diego
authors.initials: D
authors.lastname: Geroldi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001161:Arteriosclerosis / Q000209:etiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D017270:Lipoprotein(a) / Q000097:blood* / Q000235:genetics; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011110:Polymorphism, Genetic; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology*
chemical_list: D017270:Lipoprotein(a)