Relation between lipoprotein(a) and fibrinogen and serial intravascular ultrasound plaque progression in left main coronary arteries.
OBJECTIVE
Patients with elevated lipoprotein(a) [Lp(a)] and fibrinogen levels have an increased risk of coronary heart disease and adverse cardiovascular events. There is evidence that coronary plaque progression is linked to a higher risk for future cardiovascular events.


BACKGROUND
There are no data demonstrating a relation between Lp(a), fibrinogen, and directly measured coronary plaque progression over time.


METHODS
We performed a retrospective analysis of serial intravascular ultrasound (IVUS) studies of 60 left main stems (18 +/- 9 months apart) to evaluate plaque progression in relation to Lp(a) and fibrinogen levels and association with adverse cardiovascular events.


RESULTS
There was a positive correlation between Lp(a) (r = 0.58; p < 0.0001), fibrinogen (r = 0.48; p < 0.0001), and changes in plaque-plus-media area. Patients with plaque progression (n = 41) had higher Lp(a) (30 +/- 26 mg/dl vs. 14 +/- 9 mg/dl; p < 0.0012) and fibrinogen (295 +/- 88 mg/dl vs. 240 +/- 72 mg/dl; p = 0.019) levels than patients with plaque regression (n = 19). Multivariate linear regression analysis showed Log Lp(a) (regression coefficient = 9.45; p = 0.0008) but not fibrinogen to be independently associated with plaque progression. A total of 19 patients suffered from adverse cardiovascular events; they had higher Lp(a) (44 +/- 30 mg/dl vs. 16 +/- 12 mg/dl; p < 0.0001) and fibrinogen (342 +/- 73 mg/dl vs. 248 +/- 76 mg/dl; p < 0.0001) levels. Multivariate logistic regression analysis showed Log Lp(a) (odds ratio 10.20, 95% confidence interval 2.36 to 44.13; p = 0.0019) and fibrinogen (odds ratio 1.01, 95% confidence interval 1.00 to 1.03; p = 0.018) were independently associated with adverse cardiovascular events.


CONCLUSIONS
Serial IVUS showed a positive correlation between Lp(a) and fibrinogen levels and plaque progression. Lp(a), but not fibrinogen, remains independently associated with plaque progression. In addition, the present data suggest a considerable incremental value of Lp(a) in predicting cardiovascular risk.
Hartmann
Marc
M
Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands.
von Birgelen
Clemens
C
Mintz
Gary S
GS
Stoel
Martin G
MG
Eggebrecht
Holger
H
Wieneke
Heinrich
H
Fahy
Martin
M
Neumann
Till
T
van der Palen
Job
J
Louwerenburg
Hans W
HW
Verhorst
Patrick M J
PM
Erbel
Raimund
R
D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology; D003324:Coronary Artery Disease / Q000097:blood* / Q000150:complications / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D018450:Disease Progression; D005260:Female; D005340:Fibrinogen / Q000378:metabolism*; D006801:Humans; D016014:Linear Models; D017270:Lipoprotein(a) / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D017540:Tunica Media / Q000000981:diagnostic imaging; D018084:Ultrasonography, Interventional
D017270:Lipoprotein(a); D005340:Fibrinogen