Lipoprotein(a), inflammation, and peripheral arterial disease in a community-based sample of older men and women (the InCHIANTI study).
Lipoprotein(a) (Lp[a]) may represent an independent risk factor for peripheral arterial disease of the lower limbs (LL-PAD), but prospective data are scant. We estimated the association between baseline Lp(a) with prevalent and incident LL-PAD in older subjects from the InCHIANTI Study. LL-PAD, defined as an ankle-brachial index <0.90, was assessed at baseline and over a 6-year follow-up in a sample of 1,002 Italian subjects 60 to 96 years of age. Plasma Lp(a) and potential traditional and novel cardiovascular risk factors (including a score based on relevant inflammatory markers) were entered in multivariable models to assess their association with prevalent and incident LL-PAD. At baseline, Lp(a) concentration was directly related to the number of increased inflammatory markers (p <0.05). There were 125 (12.5%) prevalent cases of LL-PAD and 57 (8.3%) incident cases. After adjustment for potential confounders, participants in the highest quartile of the Lp(a) distribution (>/=32.9 mg/dl) were more likely to have LL-PAD compared to those in the lowest quartile (odds ratio [OR] 1.83, 95% confidence interval [CI] 1.01 to 3.33). The association was stronger (OR 3.80, 95% CI 1.50 to 9.61) if LL-PAD was defined by harder criteria, namely an ankle-brachial index <0.70. Compared to subjects in the lowest Lp(a) quartile, those in the highest quartile showed a somewhat increased risk of incident LL-PAD (lowest quartile 7.7%, highest quartile 10.8%), but the association was not statistically significant (OR 1.52, 95% CI 0.71 to 3.22). In conclusion, Lp(a) is an independent LL-PAD correlate in the cross-sectional evaluation, but further prospective studies in larger populations, with longer follow-up and more definite LL-PAD ranking, might be needed to establish a longitudinal association.
Department of Clinical and Experimental Medicine, University of Ferrara, Ferrara, Italy. vlt@unife.it
Stefano
S
Volpato
Giovanni B
GB
Vigna
Mary M
MM
McDermott
Margherita
M
Cavalieri
Cinzia
C
Maraldi
Fulvio
F
Lauretani
Stefania
S
Bandinelli
Giovanni
G
Zuliani
Jack M
JM
Guralnik
Renato
R
Fellin
Luigi
L
Ferrucci
D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007249:Inflammation / Q000097:blood* / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D017270:Lipoprotein(a) / Q000097:blood*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000097:blood* / Q000453:epidemiology / Q000503:physiopathology; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D016909:Tibial Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D013997:Time Factors; D018608:Ultrasonography, Doppler; D014505:Urban Population
D015415:Biomarkers; D017270:Lipoprotein(a)