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Lipoprotein(a) in Atherosclerotic Diseases: From Pathophysiology to Diagnosis and Treatment. Molecules 2023; 28:molecules28030969. [PMID: 36770634 PMCID: PMC9918959 DOI: 10.3390/molecules28030969] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
Lipoprotein(a) (Lp(a)) is a low-density lipoprotein (LDL) cholesterol-like particle bound to apolipoprotein(a). Increased Lp(a) levels are an independent, heritable causal risk factor for atherosclerotic cardiovascular disease (ASCVD) as they are largely determined by variations in the Lp(a) gene (LPA) locus encoding apo(a). Lp(a) is the preferential lipoprotein carrier for oxidized phospholipids (OxPL), and its role adversely affects vascular inflammation, atherosclerotic lesions, endothelial function and thrombogenicity, which pathophysiologically leads to cardiovascular (CV) events. Despite this crucial role of Lp(a), its measurement lacks a globally unified method, and, between different laboratories, results need standardization. Standard antilipidemic therapies, such as statins, fibrates and ezetimibe, have a mediocre effect on Lp(a) levels, although it is not yet clear whether such treatments can affect CV events and prognosis. This narrative review aims to summarize knowledge regarding the mechanisms mediating the effect of Lp(a) on inflammation, atherosclerosis and thrombosis and discuss current diagnostic and therapeutic potentials.
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Afanasieva OI, Ezhov MV, Tmoyan NA, Razova OA, Afanasieva MI, Matchin YG, Pokrovsky SN. Low Molecular Weight Apolipoprotein(a) Phenotype Rather Than Lipoprotein(a) Is Associated With Coronary Atherosclerosis and Myocardial Infarction. Front Cardiovasc Med 2022; 9:843602. [PMID: 35369320 PMCID: PMC8965702 DOI: 10.3389/fcvm.2022.843602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background and AimsCurrent evidence suggests that lipoprotein(a) [Lp(a)] level above 50 mg/dL is associated with increased cardiovascular risk. Our study aim was to determine the relationship of apolipoprotein(a) [apo(a)] phenotypes and Lp(a) concentration below and above 50 mg/dL with coronary atherosclerosis severity and myocardial infarction (MI).Material and MethodsThe study population consisted of 540 patients (mean age 54.0 ± 8.8 years, 82% men) who passed through coronary angiography. The number of diseased major coronary arteries assessed atherosclerosis severity. Lipids, glucose, Lp(a) levels and apo(a) phenotypes were determined in all patients. All patients were divided into four groups: with Lp(a) <50 mg/dL [ “normal” Lp(a)] or ≥50 mg/dL [hyperLp(a)], and with low-molecular (LMW) or high-molecular weight (HMW) apo(a) phenotypes.ResultsBaseline clinical and biochemical characteristics were similar between the groups. In groups with LMW apo(a) phenotypes, the odds ratio (OR; 95% confidence interval) of multivessel disease was higher [10.1; 3.1–33.5, p < 0.005 for hyperLp(a) and 2.2; 1.0–4.9, p = 0.056 for normal Lp(a)], but not in the group with HMW apo(a) and hyperLp(a) [1.1; 0.3–3.3, p = 0.92] compared with the reference group with HMW apo(a) and normal Lp(a). Similarly, MI was observed more often in patients with LMW apo(a) phenotype and hyperLp(a) and normal Lp(a) than in groups with HMW apo(a) phenotype.ConclusionThe LMW apo(a) phenotype is associated with the severity of coronary atherosclerosis and MI even when Lp(a) level is below 50 mg/dL. The combination of Lp(a) level above 50 mg/dL and LMW apo(a) phenotype increases the risk of severe coronary atherosclerosis, regardless of other risk factors.
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Affiliation(s)
- Olga I. Afanasieva
- National Medical Research Center of Cardiology, Institute of Experimental Cardiology, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Marat V. Ezhov
- National Medical Research Center of Cardiology, A. L. Myasnikov Institute of Clinical Cardiology, Ministry of Health of the Russian Federation, Moscow, Russia
- *Correspondence: Marat V. Ezhov
| | - Narek A. Tmoyan
- National Medical Research Center of Cardiology, A. L. Myasnikov Institute of Clinical Cardiology, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Oksana A. Razova
- National Medical Research Center of Cardiology, Institute of Experimental Cardiology, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Marina I. Afanasieva
- National Medical Research Center of Cardiology, Institute of Experimental Cardiology, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Yuri G. Matchin
- National Medical Research Center of Cardiology, A. L. Myasnikov Institute of Clinical Cardiology, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Sergei N. Pokrovsky
- National Medical Research Center of Cardiology, Institute of Experimental Cardiology, Ministry of Health of the Russian Federation, Moscow, Russia
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Sabbah N, Jaisson S, Garnotel R, Anglés-Cano E, Gillery P. Small size apolipoprotein(a) isoforms enhance inflammatory and proteolytic potential of collagen-primed monocytes. Lipids Health Dis 2019; 18:166. [PMID: 31470857 PMCID: PMC6717332 DOI: 10.1186/s12944-019-1106-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/14/2019] [Indexed: 01/03/2023] Open
Abstract
Background Atherosclerosis is an inflammatory process involving activation of monocytes recruited by various chemoattractant factors, among which lipoprotein(a) and its specific apolipoprotein apo(a). Lp(a) contains a specific apolipoprotein apo(a) which size is determined by a variable number of repeats of a specific structural domain, the kringle IV type 2 (IV-2). Lp(a) plasma concentration and apo(a) size is inversely correlated, and smaller apo(a) are major risk factors for coronary heart disease. Design and methods The aim of this study was to evaluate the effect of recombinant apo(a) isoforms (containing 10, 18 or 34 kringles) on monocytes interacting with type I collagen. Results Apo(a) isoforms stimulated reactive oxygen species (ROS) and matrix metalloproteinase-9 (MMP-9) production by monocytes, and not modified monocytes adhesion on type I collagen. This effect was specific of apo(a) since no effect was observed in the presence of plasminogen and was inversely related to apo(a) size. The lysine analogue 6-aminohexanoic acid which blocks the lysine binding sites (LBS), and carboxypeptidase B (CpB) which cleaves carboxy-terminal lysine residues, abolished apo(a)-induced ROS and MMP-9 production, highlighting an effect mediated by apo(a) lysing-binding sites. Conclusions These results indicate that activation of collagen-primed monocytes stimulated with apo(a) is a Kringle number-dependent effect and reinforce the hypothesis of a role for small size apo(a) isoforms in atherothrombosis.
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Affiliation(s)
- Nadia Sabbah
- University of Reims- Champagne-Ardenne, CNRS, MEDyC UMR 7369, Reims, France. .,Endocrinology and Metabolic Diseases Department, Cayenne hospital, Cayenne, French Guiana. .,Clinical Investigation Center Antilles French Guiana (INSERM CIC 1424), Cayenne, French Guiana.
| | - Stéphane Jaisson
- University of Reims- Champagne-Ardenne, CNRS, MEDyC UMR 7369, Reims, France.,Laboratory of Biochemisry-Pharmacology-Toxicology, University Hospital of Reims, Maison Blanche Hospital, Reims, France
| | - Roselyne Garnotel
- Laboratory of Biochemisry-Pharmacology-Toxicology, University Hospital of Reims, Maison Blanche Hospital, Reims, France
| | - Eduardo Anglés-Cano
- Inserm UMR_S1140 "Innovative Therapies in Haemostasis"Faculté de Pharmacie de Paris, Paris, France
| | - Philippe Gillery
- University of Reims- Champagne-Ardenne, CNRS, MEDyC UMR 7369, Reims, France.,Laboratory of Biochemisry-Pharmacology-Toxicology, University Hospital of Reims, Maison Blanche Hospital, Reims, France
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Ooi EM, Ellis KL, Barrett PHR, Watts GF, Hung J, Beilby JP, Thompson PL, Stobie P, McQuillan BM. Lipoprotein(a) and apolipoprotein(a) isoform size: Associations with angiographic extent and severity of coronary artery disease, and carotid artery plaque. Atherosclerosis 2018; 275:232-238. [PMID: 29960898 DOI: 10.1016/j.atherosclerosis.2018.06.863] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 06/09/2018] [Accepted: 06/15/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Lipoprotein(a) [Lp(a)] is an emerging genetic risk factor for cardiovascular disease (CVD). We examined whether plasma Lp(a) concentration and apolipoprotein(a) [apo(a)] isoform size are associated with extent and severity of coronary artery disease (CAD), and the presence of carotid artery plaque. METHODS We included in our study male participants (n = 263) from a cohort with angiographically defined premature CAD (Carotid Ultrasound in Patients with Ischemic Heart Disease). The angiographic extent and severity of CAD were determined by the modified Gensini and Coronary Artery Stenosis≥20% (CAGE) scores. Carotid artery plaque was assessed by bilateral carotid B-mode ultrasound. Apo(a) isoform size was determined by LPA Kringle IV-2 copy number (KIV-2 CN). RESULTS Lp(a) concentration, but not KIV-2 CN, was positively associated with the Gensini score. The association remained significant following adjustment for conventional CVD risk factors (all p < 0.05). Lp(a) concentration and elevated Lp(a) [≥50 mg/dL] were positively associated with the CAGE≥20 score, independent of conventional CVD risk factors. KIV-2 C N Q1 (lowest KIV-2 CN quartile) was associated with CAGE≥20 score and KIV-2 CN, with the CAGE≥20 score in those without diabetes. In multivariate models that included phenotypic familial hypercholesterolemia or low-density lipoprotein cholesterol, Lp(a) concentration, but not KIV-2 CN, was independently associated with the Gensini and CAGE≥20 scores. No significant associations between Lp(a) concentration and KIV-2 CN with carotid artery plaque were observed. CONCLUSIONS Lp(a) concentration, but not apo(a) isoform size, is independently associated with angiographic extent and severity of CAD. Neither Lp(a) nor apo(a) isoform size is associated with carotid artery plaque.
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Affiliation(s)
- Esther Mm Ooi
- School of Biomedical Sciences, The University of Western Australia, Perth, Australia
| | - Katrina L Ellis
- School of Biomedical Sciences, The University of Western Australia, Perth, Australia; Medical School, University of Western Australia, Perth, Australia
| | - P Hugh R Barrett
- School of Biomedical Sciences, The University of Western Australia, Perth, Australia
| | - Gerald F Watts
- Medical School, University of Western Australia, Perth, Australia; Lipid Disorders Clinic, Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital, Perth, Australia
| | - Joseph Hung
- Medical School, University of Western Australia, Perth, Australia; Cardiovascular Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - John P Beilby
- PathWest Laboratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Peter L Thompson
- Medical School, University of Western Australia, Perth, Australia; Cardiovascular Medicine, Sir Charles Gairdner Hospital, Perth, Australia; Heart Research Institute, QEII Medical Center, Perth, Australia
| | - Paul Stobie
- Cardiovascular Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Brendan M McQuillan
- Medical School, University of Western Australia, Perth, Australia; Cardiovascular Medicine, Sir Charles Gairdner Hospital, Perth, Australia.
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Thomas T, Zhou H, Karmally W, Ramakrishnan R, Holleran S, Liu Y, Jumes P, Wagner JA, Hubbard B, Previs SF, Roddy T, Johnson-Levonas AO, Gutstein DE, Marcovina SM, Rader DJ, Ginsberg HN, Millar JS, Reyes-Soffer G. CETP (Cholesteryl Ester Transfer Protein) Inhibition With Anacetrapib Decreases Production of Lipoprotein(a) in Mildly Hypercholesterolemic Subjects. Arterioscler Thromb Vasc Biol 2017; 37:1770-1775. [PMID: 28729361 PMCID: PMC5567403 DOI: 10.1161/atvbaha.117.309549] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/04/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Lp(a) [lipoprotein (a)] is composed of apoB (apolipoprotein B) and apo(a) [apolipoprotein (a)] and is an independent risk factor for cardiovascular disease and aortic stenosis. In clinical trials, anacetrapib, a CETP (cholesteryl ester transfer protein) inhibitor, causes significant reductions in plasma Lp(a) levels. We conducted an exploratory study to examine the mechanism for Lp(a) lowering by anacetrapib. APPROACH AND RESULTS We enrolled 39 participants in a fixed-sequence, double-blind study of the effects of anacetrapib on the metabolism of apoB and high-density lipoproteins. Twenty-nine patients were randomized to atorvastatin 20 mg/d, plus placebo for 4 weeks, and then atorvastatin plus anacetrapib (100 mg/d) for 8 weeks. The other 10 subjects were randomized to double placebo for 4 weeks followed by placebo plus anacetrapib for 8 weeks. We examined the mechanisms of Lp(a) lowering in a subset of 12 subjects having both Lp(a) levels >20 nmol/L and more than a 15% reduction in Lp(a) by the end of anacetrapib treatment. We performed stable isotope kinetic studies using 2H3-leucine at the end of each treatment to measure apo(a) fractional catabolic rate and production rate. Median baseline Lp(a) levels were 21.5 nmol/L (interquartile range, 9.9-108.1 nmol/L) in the complete cohort (39 subjects) and 52.9 nmol/L (interquartile range, 38.4-121.3 nmol/L) in the subset selected for kinetic studies. Anacetrapib treatment lowered Lp(a) by 34.1% (P≤0.001) and 39.6% in the complete and subset cohort, respectively. The decreases in Lp(a) levels were because of a 41% reduction in the apo(a) production rate, with no effects on apo(a) fractional catabolic rate. CONCLUSIONS Anacetrapib reduces Lp(a) levels by decreasing its production. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00990808.
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Affiliation(s)
- Tiffany Thomas
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Haihong Zhou
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Wahida Karmally
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Rajasekhar Ramakrishnan
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Stephen Holleran
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Yang Liu
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Patricia Jumes
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - John A Wagner
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Brian Hubbard
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Stephen F Previs
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Thomas Roddy
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Amy O Johnson-Levonas
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - David E Gutstein
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Santica M Marcovina
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Daniel J Rader
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Henry N Ginsberg
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - John S Millar
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.)
| | - Gissette Reyes-Soffer
- From the Columbia University, New York (T.T., W.K., R.R., S.H., H.N.G., G.R.-S.); Merck & Co, Inc, Kenilworth, NJ (H.Z., Y.L., P.J., J.A.W., B.H., S.F.P., T.R., A.O.J.-L., D.E.G.); University of Washington, Seattle (S.M.M.); and University of Pennsylvania, Philadelphia (D.J.R., J.S.M.).
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Song ZK, Cao HY, Wu HD, Zhou LT, Qin L. A Case-Control Study of the Relationship Between SLC22A3-LPAL2-LPA Gene Cluster Polymorphism and Coronary Artery Disease in the Han Chinese Population. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e35387. [PMID: 27621937 PMCID: PMC5010879 DOI: 10.5812/ircmj.35387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 04/28/2016] [Accepted: 05/20/2016] [Indexed: 11/18/2022]
Abstract
Background Mutations in the solute carrier family 22 member 3 (SLC22A3), lipoprotein (a)-like 2 (LPAL2), and the lipoprotein (a) (LPA) gene cluster, which encodes apolipoprotein (a) [apo (a)] of the lipoprotein (a) [Lp (a)] lipoprotein particle, have been suggested to contribute to the risk of coronary artery disease (CAD), but the precise variants of this gene cluster have not yet been identified in Chinese populations. Objectives We sought to investigate the association between SLC22A3-LPAL2-LPA gene cluster polymorphisms and the risk of CAD in the Han Chinese population. Patients and Methods We recruited 551 CAD patients and 544 healthy controls for this case-control study. Four SNPs (rs9346816, rs2221750, rs3127596, and rs9364559) were genotyped in real time using the MassARRAY system (Sequenom; USA) in the SLC22A3-LPAL2-LPA gene cluster. All subjects were Chinese and of Han descent, and were recruited from the First Hospital of Jilin University based on convenience sampling from June 2009 to September 2012. Results The frequency of the minor allele G (34.8%) in rs9364559 was significantly higher in the CAD patients than in the healthy controls (29.4%) (P = 0.006). There was genotypic association between rs9364559 and CAD (P = 0.022), and these results still remained significant after adjustment for the conventional CAD risk factors through forward logistic regression analysis (P = 0.020, P = 0.019). Haplotype analyses from different blocks indicated that 11 haplotypes were associated with the risk of CAD. Seven haplotypes were associated with a reduced risk of CAD, whereas four haplotypes were associated with an increased risk of CAD. Conclusions Rs9364559 in the LPA gene may contribute to the risk of CAD in the Han Chinese population; haplotypes which contain rs9346816-G were all associated with an increased risk of CAD in this study.
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Affiliation(s)
- Zi-Kai Song
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Hong-Yan Cao
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Hai-Di Wu
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Li-Ting Zhou
- Department of Occupational and Environmental Health, School of Public Health, Jilin University, Changchun, China
| | - Ling Qin
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
- Corresponding Author: Ling Qin, Department of Cardiology, The First Hospital of Jilin University, Changchun, China. Tel: +86-15843073203; Fax: +86-043184841049, E-mail:
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Poly-(R)-3-hydroxybutyrates (PHB) are Atherogenic Components of Lipoprotein Lp(a). Med Hypotheses 2015; 85:1041-3. [DOI: 10.1016/j.mehy.2015.07.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 07/24/2015] [Accepted: 07/29/2015] [Indexed: 11/25/2022]
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Willey JZ, Moon YP, Kahn E, Rodriguez CJ, Rundek T, Cheung K, Sacco RL, Elkind MSV. Population attributable risks of hypertension and diabetes for cardiovascular disease and stroke in the northern Manhattan study. J Am Heart Assoc 2014; 3:e001106. [PMID: 25227406 PMCID: PMC4323833 DOI: 10.1161/jaha.114.001106] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 08/07/2014] [Indexed: 01/24/2023]
Abstract
BACKGROUND Understanding the population-level risk factor contribution to disease incidence is critical for effective allocation of resources for prevention. There are little data on the contribution of cardiovascular disease (CVD) risk factors in multiethnic elderly populations. METHODS AND RESULTS The Northern Manhattan Study (n=3298) is a population-based prospective cohort study of CVD outcomes in a multiethnic urban population. Multivariable Cox's models were used to calculate hazard ratios, population attributable risk (PAR), and 95% confidence intervals (CIs) for (1) combined vascular event (VE) endpoint of stroke/myocardial infarction/vascular death (n=835) and (2) stroke (n=347). The PAR resulting from hypertension (HTN) was 24.3% (95% CI, 13.2 to 35.4) for VE and 29.9% (95% CI, 12.5 to 47.4) for stroke; PAR resulting from diabetes was 12.7% (95% CI, 8.2 to 17.2) for VE and 19.5% (95% CI, 12.4 to 26.5) for stroke. The PAR resulting from HTN and diabetes for stroke differed by race-ethnicity and age (P for differences <0.05). PAR for stroke reslting from HTN was greater among Hispanics (50.6%; 95% CI, 29.2 to 71.9) than non-Hispanic whites (2.6%; 95% CI, -33.2 to 38.6) and in those <80 years of age (35.6%; 95% CI, 18.9 to 52.3) than in those ≥80 (-0.3%; 95% CI, -34.2 to 33.6). Similarly, the PAR for stroke resulting from diabetes was 23.6% among those <80 years of age (95% CI, 15.7 to 31.5) and 2.3% among those ≥80 (95% CI, -8.2 to 12.7; P for difference=0.001). The PAR for VE did not differ by age/sex/race-ethnicity. CONCLUSIONS HTN and diabetes have important effects on the burden of stroke, particularly among those younger than age 80 and Hispanics. Public health campaigns targeted at specific risk factors in specific populations can lead to a greater reduction in CVD.
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Affiliation(s)
- Joshua Z. Willey
- Department of Neurology, Columbia University, New York, USA (J.Z.W., Y.P.M., E.K., M.V.E.)
| | - Yeseon Park Moon
- Department of Neurology, Columbia University, New York, USA (J.Z.W., Y.P.M., E.K., M.V.E.)
| | - Emily Kahn
- Department of Neurology, Columbia University, New York, USA (J.Z.W., Y.P.M., E.K., M.V.E.)
| | - Carlos J. Rodriguez
- Department of Medicine, Wake Forest University, Winston‐Salem, NC, USA (C.J.R.)
| | - Tatjana Rundek
- Department of Neurology, University of Miami, Miami, FL, USA (T.R., R.L.S.)
| | - Ken Cheung
- Department of Biostatistics, Columbia University, New York, USA (K.C.)
| | - Ralph L. Sacco
- Department of Neurology, University of Miami, Miami, FL, USA (T.R., R.L.S.)
| | - Mitchell S. V. Elkind
- Department of Neurology, Columbia University, New York, USA (J.Z.W., Y.P.M., E.K., M.V.E.)
- Department of Epidemiology, Columbia University, New York, USA (M.V.E.)
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Willey JZ, Gardener H, Moon YP, Yoshita M, DeCarli C, Cheung YK, Sacco RL, Elkind MSV, Wright CB. Lipid profile components and subclinical cerebrovascular disease in the northern Manhattan study. Cerebrovasc Dis 2014; 37:423-30. [PMID: 25034465 DOI: 10.1159/000362920] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 04/10/2014] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Subclinical cerebrovascular disease has been associated with multiple adverse events related to aging, including stroke and dementia. The modifiable risk factors for subclinical cerebrovascular disease beyond hypertension have not been well characterized. Our objective was to examine the association between baseline, and changes over time, in lipid profile components and subclinical cerebrovascular disease on magnetic resonance imaging (MRI). METHODS Fasting plasma lipids were collected on participants in the Northern Manhattan Study, a prospective cohort study examining risk factors for cardiovascular disease in a multiethnic elderly urban-dwelling population. A subsample of the cohort underwent brain MRI between 2003 and 2008 (a median of 6.2 years, range = 0-14, after enrollment), when repeat fasting lipids were obtained. We used lipid profile components at the time of initial enrollment (n = 1,256 with lipids available) as categorical variables, as well as change in clinical categories over the two measures (n = 1,029). The main outcome measures were (1) total white matter hyperintensity volume (WMHV) using linear regression and (2) silent brain infarcts (SBI) using logistic regression. RESULTS None of the plasma lipid profile components at the time of enrollment were associated with WMHV. The association between baseline lipids and WMHV was, however, modified by apolipoprotein E (apoE) status (χ(2) with 2 degrees of freedom, p = 0.03), such that among apoE4 carriers those with total cholesterol (TC) ≥200 mg/dl had a trend towards smaller WMHV than those with TC <200 mg/dl (difference in logWMHV -0.19, p = 0.07), while there was no difference among apoE3 carriers. When examining the association between WMHV and change in lipid profile components we noted an association with change in high-density lipoprotein cholesterol (HDL-C, >50 mg/dl for women, >40 mg/dl for men) and TC. A transition from low-risk HDL-C (>50 mg/dl for women, >40 mg/dl for men) at baseline to high-risk HDL-C at the time of MRI (vs. starting and remaining low risk) was associated with greater WMHV (difference in logWMHV 0.34, p value 0.03). We noted a similar association with transitioning to a TC ≥200 mg/dl at the time of MRI (difference in logWMHV 0.25, p value 0.006). There were no associations with baseline or change in lipid profile components with SBI. CONCLUSIONS The association of plasma lipid profile components with greater WMHV may depend on apoE genotype and worsening HDL and TC risk levels over time.
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Affiliation(s)
- Joshua Z Willey
- Department of Neurology, Columbia University, New York, N.Y., USA
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11
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Calmarza P, Trejo JM, Lapresta C, Lopez P. Lack of association between carotid intima-media thickness and apolipoprotein (a) isoforms in a sample of Spanish general population. J Cardiol 2013; 61:372-7. [DOI: 10.1016/j.jjcc.2013.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 12/05/2012] [Accepted: 01/10/2013] [Indexed: 11/30/2022]
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12
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Willey JZ, Rodriguez CJ, Moon YP, Paik MC, Di Tullio MR, Homma S, Sacco RL, Elkind MSV. Coronary death and myocardial infarction among Hispanics in the Northern Manhattan Study: exploring the Hispanic paradox. Ann Epidemiol 2012; 22:303-9. [PMID: 22424967 DOI: 10.1016/j.annepidem.2012.02.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 02/20/2012] [Accepted: 02/21/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Prior studies have reported that Hispanics have lower cardiovascular disease (CVD) mortality despite a higher burden of risk factors. We examined whether Hispanic ethnicity was associated with a lower risk of nonfatal myocardial infarction (MI) coronary death (CD) and vascular death. METHODS A total of 2671 participants in the Northern Manhattan Study without clinical CVD were prospectively evaluated. Cox models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI) for the association of race-ethnicity with nonfatal MI, CD, and vascular death after adjusting for demographic and CVD risk factors. RESULTS Mean age was 68.8 (10.4) years; 52.8% were Hispanic (88% Caribbean-Hispanic). Hispanics were more likely to have hypertension (73.1% vs. 62.2%, p < .001) and diabetes (22.0% vs. 13.3%, p < .001), and less likely to perform any physical activity (50.1% vs. 69.2%, p < .001) compared to non-Hispanic whites (NHW). During a mean 10 years of follow-up there were 154 nonfatal MIs, 186 CD, and 386 vascular deaths. In fully adjusted models, Hispanics had a lower risk of CD (adjusted HR = 0.36, 95% CI: 0.21-0.60), and vascular death (adjusted HR = 0.62, 95% CI: 0.43-0.89), but not nonfatal MI (adjusted HR = 0.95, 95% CI: 0.56-1.60) when compared to NHW. CONCLUSIONS We found a "Hispanic paradox" for coronary and vascular deaths, but not nonfatal MI.
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Affiliation(s)
- Joshua Z Willey
- Department of Neurology, Columbia University, New York, NY, USA.
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13
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Virani SS, Brautbar A, Davis BC, Nambi V, Hoogeveen RC, Sharrett AR, Coresh J, Mosley TH, Morrisett JD, Catellier DJ, Folsom AR, Boerwinkle E, Ballantyne CM. Associations between lipoprotein(a) levels and cardiovascular outcomes in black and white subjects: the Atherosclerosis Risk in Communities (ARIC) Study. Circulation 2012; 125:241-9. [PMID: 22128224 PMCID: PMC3760720 DOI: 10.1161/circulationaha.111.045120] [Citation(s) in RCA: 216] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 10/31/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND On the basis of studies with limited statistical power, lipoprotein(a) [Lp(a)] is not considered a risk factor for cardiovascular disease (CVD) in blacks. We evaluated associations between Lp(a) and incident CVD events in blacks and whites in the Atherosclerosis Risk in Communities (ARIC) study. METHODS AND RESULTS Plasma Lp(a) was measured in blacks (n=3467) and whites (n=9851). Hazards ratios (HRs) for incident CVD events (coronary heart disease and ischemic strokes) were calculated. Lp(a) levels were higher with wider interindividual variation in blacks (median [interquartile range], 12.8 [7.1-21.7] mg/dL) than whites (4.3 [1.7-9.5] mg/dL; P<0.0001). At 20 years of follow-up, 676 CVD events occurred in blacks, and 1821 events occurred in whites. Adjusted HRs (95% confidence interval) per race-specific 1-SD-greater log-transformed Lp(a) were 1.13 (1.04-1.23) for incident CVD, 1.11 (1.00-1.22) for incident coronary heart disease, and 1.21 (1.06-1.39) for ischemic strokes in blacks. For whites, the respective HRs (95% confidence intervals) were 1.09 (1.04-1.15), 1.10 (1.05-1.16), and 1.07 (0.97-1.19). Quintile analyses showed that risk for incident CVD was graded but statistically significant only for the highest compared with the lowest quintile (HR [95% confidence interval], 1.35 [1.06-1.74] for blacks and 1.27 [1.10-1.47] for whites). Similar results were obtained with the use of Lp(a) cutoffs of ≤10 mg/dL, >10 to ≤20 mg/dL, >20 to ≤30 mg/dL, and >30 mg/dL. CONCLUSIONS Lp(a) levels were positively associated with CVD events. Associations were at least as strong, with a larger range of Lp(a) concentrations, in blacks compared with whites.
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Affiliation(s)
- Salim S. Virani
- Michael E. DeBakey VA Medical Center Health Services Rsrch & Development Ctr of Excellence, Houston, TX
- Section of Cardiovascular Rsrch, Dept of Medicine, Baylor College of Med & Ctr for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX
| | - Ariel Brautbar
- Section of Cardiovascular Rsrch, Dept of Medicine, Baylor College of Med & Ctr for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX
| | - Brian C. Davis
- University of Texas Health Science Ctr at Houston, Houston, TX
| | - Vijay Nambi
- Section of Cardiovascular Rsrch, Dept of Medicine, Baylor College of Med & Ctr for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX
| | - Ron C. Hoogeveen
- Section of Cardiovascular Rsrch, Dept of Medicine, Baylor College of Med & Ctr for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX
| | - A. Richey Sharrett
- Dept of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Josef Coresh
- Dept of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | | | - Joel D. Morrisett
- Section of Cardiovascular Rsrch, Dept of Medicine, Baylor College of Med & Ctr for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX
| | - Diane J. Catellier
- Dept of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Aaron R. Folsom
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Eric Boerwinkle
- University of Texas Health Science Ctr at Houston, Houston, TX
| | - Christie M. Ballantyne
- Section of Cardiovascular Rsrch, Dept of Medicine, Baylor College of Med & Ctr for Cardiovascular Disease Prevention, Methodist DeBakey Heart and Vascular Center, Houston, TX
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Enkhmaa B, Anuurad E, Zhang W, Tran T, Berglund L. Lipoprotein(a): genotype-phenotype relationship and impact on atherogenic risk. Metab Syndr Relat Disord 2011; 9:411-8. [PMID: 21749171 DOI: 10.1089/met.2011.0026] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In 2010, more than 45 years after the initial discovery of lipoprotein(a) [Lp(a)] by Kare Berg, an European Atherosclerosis Society Consensus Panel recommended screening for elevated Lp(a) in people at moderate to high risk of atherosclerotic cardiovascular disease (CVD). This recommendation was based on extensive epidemiological findings demonstrating a significant association between elevated plasma Lp(a) levels and coronary heart disease, myocardial infarction, and stroke. In addition to those patients considered to be at moderate to high risk of heart disease, statin-treated patients with recurrent heart disease were also identified as targeted for screening of elevated Lp(a) levels. Taken together, recent findings have significantly strengthened the notion of Lp(a) as a causal risk factor for CVD. It is well established that Lp(a) levels are largely determined by the size of the apolipoprotein a [apo(a)] gene; however, recent studies have identified several other LPA gene polymorphisms that have significant associations with an elevated Lp(a) level and a reduced copy number of K4 repeats. In addition, the contribution of other genes in regulating Lp(a) levels has been described. Besides the strong genetic regulation, new evidence has emerged regarding the impact of inflammation as a modulator of Lp(a) risk factor properties. Thus, oxidized phospholipids that possess a strong proinflammatory potential are preferentially carried on Lp(a) particles. Collectively, these findings point to the importance of both phenotypic and genotypic factors in influencing apo(a) proatherogenic properties. Therefore, studies taking both of these factors into account determining the amount of Lp(a) associated with each individual apo(a) size allele are valuable tools when assessing a risk factor role of Lp(a).
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Affiliation(s)
- Byambaa Enkhmaa
- Department of Medicine, University of California, Davis, USA
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15
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Willey JZ, Rodriguez CJ, Carlino RF, Moon YP, Paik MC, Boden-Albala B, Sacco RL, DiTullio MR, Homma S, Elkind MSV. Race-ethnic differences in the association between lipid profile components and risk of myocardial infarction: The Northern Manhattan Study. Am Heart J 2011; 161:886-92. [PMID: 21570518 DOI: 10.1016/j.ahj.2011.01.018] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 01/31/2011] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this study was to explore race-ethnic differences in the association between plasma lipid components and risk of incident myocardial infarction (MI). DESIGN/METHODS As part of the Northern Manhattan Study, 2,738 community residents without cardiovascular disease were prospectively evaluated. Baseline fasting blood samples were collected, and lipid panel components were analyzed as continuous and categorical variables. Cox proportional hazards models were used to calculate HRs and 95% CIs for incident MI after adjusting for demographic and cardiovascular risk factors. RESULTS The mean age was 68.8 ± 10.4 years; 36.7% were men. Of the participants, 19.9% were non-Hispanic white; 24.9%, non-Hispanic black; and 52.8%, Hispanic (>80% from the Caribbean). Hispanics had lower mean high-density lipoprotein cholesterol (HDL-C) and higher triglycerides (TG)/HDL-C. During a mean 8.9 years of follow-up, there were 163 incident MIs. In the whole cohort, all lipid profile components were associated with risk of MI in the expected directions. However, HDL-C (adjusted HR per 10 mg/dL increase 0.93, 95% CI 0.76-1.12) and TG/HDL-C >2 (adjusted HR 0.89, 95% CI 0.51-1.55) were not predictive of MI among Hispanics but were predictive among non-Hispanic blacks and whites. Triglycerides/HDL-C per unit increase was associated with an 8% higher risk of MI among Hispanics (adjusted HR 1.08, 95% CI 1.04-1.12). CONCLUSIONS In Hispanics, low HDL-C and TG/HDL-C >2 were not associated with MI risk. Our data suggest that a different TG/HDL ratio cutoff may be needed among Hispanics to predict MI risk.
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Affiliation(s)
- Joshua Z Willey
- Department of Neurology, Columbia University, New York, NY, USA.
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16
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Anuurad E, Enkhmaa B, Berglund L. Enigmatic role of lipoprotein(a) in cardiovascular disease. Clin Transl Sci 2011; 3:327-32. [PMID: 21167011 DOI: 10.1111/j.1752-8062.2010.00238.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Lipoprotein (a), [Lp(a)] has many properties in common with low-density lipoprotein, (LDL) but contains a unique protein apolipoprotein(a), linked to apolipoprotein B-100 by a single disulfide bond. There is a substantial size heterogeneity of apo(a), and generally smaller apo(a) sizes tend to correspond to higher plasma Lp(a) levels, but this relation is far from linear, underscoring the importance to assess allele-specific apo(a) levels. The presence of apo(a), a highly charged, carbohydrate-rich, hydrophilic protein may obscure key features of the LDL moiety and offer opportunities for binding to vessel wall elements. Recently, interest in Lp(a) has increased because studies over the past decade have confirmed and more robustly demonstrated a risk factor role of Lp(a) for cardiovascular disease. In particular, levels of Lp(a) carried in particles with smaller size apo(a) isoforms are associated with coronary artery disease (CAD). Other studies suggest that proinflammatory conditions may modulate risk factor properties of Lp(a). Further, Lp(a) may act as a preferential acceptor for proinflammatory oxidized phospholipids transferred from tissues or from other lipoproteins. However, at present only a limited number of agents (e.g., nicotinic acid and estrogen) has proven efficacy in lowering Lp(a) levels. Although Lp(a) has not been definitely established as a cardiovascular risk factor and no guidelines presently recommend intervention, Lp(a)-lowering therapy might offer benefits in subgroups of patients with high Lp(a) levels.
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Lupattelli G, Roscini AR, Siepi D, Mannarino E. Case report. Hyperlipoproteinaemia(a): which is the optimal therapy? A case report. J Clin Pharm Ther 2010; 35:613-5. [PMID: 20831686 DOI: 10.1111/j.1365-2710.2009.01118.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This case report presents the clinical history of a patient with elevated lipoprotein(a) and small size isoform, associated with mixed hyperlipaemia, which was probably familial combined hyperlipaemia. After premature myocardial infarction, the subject was treated with fibrates. Niacin was started after recurrence. One year ago, after another episode of acute coronary syndrome, rosuvastatin was added to niacin. The atherogenicity of this lipid disorder, along with the different options for therapy is discussed.
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Affiliation(s)
- G Lupattelli
- Unit of Internal Medicine, Angiology and Atherosclerosis, Department of Clinical and Experimental Medicine, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy.
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Della-Morte D, Gardener H, Denaro F, Boden-Albala B, Elkind MSV, Paik MC, Sacco RL, Rundek T. Metabolic syndrome increases carotid artery stiffness: the Northern Manhattan Study. Int J Stroke 2010; 5:138-44. [PMID: 20536608 DOI: 10.1111/j.1747-4949.2010.00421.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Arterial stiffness, an intermediate pre-clinical marker of atherosclerosis, has been associated with an increased risk of stroke and cardiovascular disease. The metabolic syndrome and its components are established cardiovascular disease risk factors and may also increase arterial stiffness; however, data regarding this are limited. AIM The goal of this study was to determine the association between the metabolic syndrome and carotid artery stiffness in an elderly multi-ethnic cohort. METHODS Carotid artery stiffness was assessed by carotid ultrasound as part of the Northern Manhattan Study, a prospective population-based cohort of stroke-free individuals. Carotid artery stiffness was calculated as [ln(systolic BP/diastolic BP)/strain], where strain was [(systolic diameter-diastolic diameter)/diastolic diameter]. Metabolic syndrome was defined by the National Cholesterol Education Program: Adult Treatment Panel III criteria. LogSTIFF was analysed as the dependent variable in linear regression models, adjusting for demographics, education, current smoking, presence of carotid plaque and intima-media thickness. RESULTS Carotid artery stiffness was analysed in 1133 Northern Manhattan Study subjects (mean age 65 +/- 9 years; 61% women; 58% Hispanic, 22% Black and 20% Caucasian). The prevalence of the metabolic syndrome was 49%. The mean LogSTIFF was 2.01 +/- 0.61 among those with the metabolic syndrome and 1.90 +/- 0.59 among those without the metabolic syndrome (P=0.003). The metabolic syndrome was significantly associated with increased logSTIFF in the final adjusted model (parameter estimate beta=0.100, P=0.01). Among individual metabolic syndrome components, waist circumference and elevated blood pressure were most significantly associated with a mean increase in logSTIFF (P<0.01). CONCLUSION The metabolic syndrome is significantly associated with increased carotid artery stiffness in a multiethnic population. Increased carotid artery stiffness may, in part, explain a high risk of stroke among individuals with the metabolic syndrome.
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Affiliation(s)
- David Della-Morte
- Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL 33101, USA
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19
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Yoshida S, Aihara KI, Azuma H, Uemoto R, Sumitomo-Ueda Y, Yagi S, Ikeda Y, Iwase T, Nishio S, Kawano H, Miki J, Yamada H, Hirata Y, Akaike M, Sata M, Matsumoto T. Dehydroepiandrosterone sulfate is inversely associated with sex-dependent diverse carotid atherosclerosis regardless of endothelial function. Atherosclerosis 2010; 212:310-5. [DOI: 10.1016/j.atherosclerosis.2010.05.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2009] [Revised: 04/01/2010] [Accepted: 05/06/2010] [Indexed: 11/16/2022]
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Gardener H, Della Morte D, Elkind MSV, Sacco RL, Rundek T. Lipids and carotid plaque in the Northern Manhattan Study (NOMAS). BMC Cardiovasc Disord 2009; 9:55. [PMID: 20028534 PMCID: PMC2804671 DOI: 10.1186/1471-2261-9-55] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Accepted: 12/22/2009] [Indexed: 02/02/2023] Open
Abstract
Background Lipids, particularly low-density (LDL) and high-density (HDL) lipoproteins, are associated with increased risk of stroke and cardiovascular disease, probably due to atherosclerosis. The objective of this cross-sectional analysis was to investigate the relation between blood lipids and carotid plaque. Methods As part of a prospective population-based study to determine the incidence and risk factors of stroke in a multiethnic population, we evaluated 1804 participants with lipid measurements and B-mode ultrasound of carotid arteries (mean age 69 +/- 10 years; 40% men; 51% Hispanic, 26% black, 23% white). The association between lipid parameters and carotid plaque was analyzed by multiple logistic regression. Results Plaque was present in 61% of participants. Mean total cholesterol was 202 +/- 41 mg/dl. After controlling for other lipid parameters, demographics, and risk factors, the only cholesterol subfraction associated with carotid plaque was LDL (OR per standard deviation (SD) = 1.14, 95% CI 1.02-1.27). Neither HDL nor triglycerides independently predicted carotid plaque. Apolipoprotein B (ApoB) was also associated with risk of plaque (OR per SD = 1.29, 95% CI 1.03-1.60). Apolipoprotein A-I (apoA-1) was associated with a decrease in multiple plaques (OR per SD = 0.76, 95% CI 0.60-0.97), while lipoprotein a was associated with an increased risk of multiple plaques (OR per SD = 1.31, 95% CI 1.03-1.66). ApoB:ApoA-I had the strongest relation with carotid plaque (OR per SD = 1.35, 95% CI 1.08-1.69). Conclusions Among the common lipid parameters, LDL has the strongest relation with carotid plaque. Other lipid precursor proteins such as ApoB and ApoA-I may be stronger predictors of subclinical atherosclerosis, however, and better targets for treatment to reduce plaque formation and risk of cerebrovascular disease.
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Affiliation(s)
- Hannah Gardener
- Department of Neurology, Miller School of Medicine, University of Miami, FL, USA.
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21
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Willey JZ, Xu Q, Boden-Albala B, Paik MC, Moon YP, Sacco RL, Elkind MSV. Lipid profile components and risk of ischemic stroke: the Northern Manhattan Study (NOMAS). ACTA ACUST UNITED AC 2009; 66:1400-6. [PMID: 19901173 DOI: 10.1001/archneurol.2009.210] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To explore the relationship between lipid profile components and incident ischemic stroke in a stroke-free prospective cohort. DESIGN Population-based prospective cohort study. SETTING Northern Manhattan, New York. PATIENTS Stroke-free community residents. Intervention As part of the Northern Manhattan Study, baseline fasting blood samples were collected on stroke-free community residents followed up for a mean of 7.5 years. MAIN OUTCOME MEASURES Cox proportional hazard models were used to calculate hazard ratios and 95% confidence intervals for lipid profile components and ischemic stroke after adjusting for demographic and risk factors. In secondary analyses, we used repeated lipid measures over 5 years from a 10% sample of the population to calculate the change per year of each of the lipid parameters and to impute time-dependent lipid parameters for the full cohort. RESULTS After excluding those with a history of myocardial infarction, 2940 participants were available for analysis. Baseline high-density lipoprotein cholesterol, triglyceride, and total cholesterol levels were not associated with risk of ischemic stroke. Low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol levels were associated with a paradoxical reduction in risk of stroke. There was an interaction with use of cholesterol-lowering medication on follow-up, such that LDL-C level was only associated with a reduction in stroke risk among those taking medications. An LDL-C level greater than 130 mg/dL as a time-dependent covariate showed an increased risk of ischemic stroke (adjusted hazard ratio, 3.81; 95% confidence interval, 1.53-9.51). CONCLUSIONS Baseline lipid panel components were not associated with an increased stroke risk in this cohort. Treatment with cholesterol-lowering medications and changes in LDL-C level over time may have attenuated the risk in this population, and lipid measurements at several points may be a better marker of stroke risk.
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Affiliation(s)
- Joshua Z Willey
- Department of Neurology, College of Physicians and Surgeons, Joseph P. Mailman School of Public Health, Columbia University, and the Columbia University Medical Center of New York Presbyterian Hospital, New York, NY 10032, USA
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Beavers KM, Beavers DP, Bowden RG, Wilson RL, Gentile M. Effect of Over-the-Counter Fish-Oil Administration on Plasma Lp(a) Levels in an End-Stage Renal Disease Population. J Ren Nutr 2009; 19:443-9. [DOI: 10.1053/j.jrn.2009.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Indexed: 11/11/2022] Open
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Taylor HA, Akylbekova EL, Garrison RJ, Sarpong D, Joe J, Walker E, Wyatt SB, Steffes MW. Dyslipidemia and the treatment of lipid disorders in African Americans. Am J Med 2009; 122:454-63. [PMID: 19375555 DOI: 10.1016/j.amjmed.2008.09.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Revised: 09/17/2008] [Accepted: 09/24/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND Despite the high prevalence of cardiovascular disease documented among the African-American population, there has been little emphasis on the role of dyslipidemia as a prominent risk factor in this large subpopulation. Questions of medication efficacy also have been raised. Together, these factors may have affected awareness, diagnosis, and treatment rates. METHODS AND RESULTS Dyslipidemia was defined as the presence of either hypercholesterolemia or hypertriglyceridemia using National Cholesterol Education Program III criteria and the fasting lipid measurements, self-reported treatment history, and medication survey available from 5302 Jackson Heart Study participants. Dyslipidemia was more common in men (compared with women) aged less than 50 years and increased with age in both genders. Hypercholesterolemia prevalence rates approached 50% in women aged more than 65 years. The lifestyle-related attributes found to be related to prevalence were being overweight and less physically active, and all disease status variables exhibited significant (P<.05) associations. Awareness of hypercholesterolemia is approximately 55% or more in both men and women aged more than 35 years. Treatment rates lag far behind awareness, particularly in younger adult men, and less than 50% of women and men aged less than 65 years were treated for hypercholesterolemia. CONCLUSION Higher rates of identification and effective treatment of dyslipidemia are clearly needed in this, and probably other African-American communities. Despite the less than optimal treatment, the identification and importance of the known cardiovascular disease states and risk factors in these analyses suggest the adoption of National Cholesterol Education Program III "high-risk strategy" algorithms in treatment recommendations and decisions by providers is occurring.
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Affiliation(s)
- Herman A Taylor
- University of Mississippi Medical Center, Jackson Heart Study, Jackson, Miss., USA
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Endothelial dysfunction in African-Americans. Int J Cardiol 2008; 132:157-72. [PMID: 19004510 DOI: 10.1016/j.ijcard.2008.10.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2008] [Revised: 07/25/2008] [Accepted: 10/12/2008] [Indexed: 01/13/2023]
Abstract
The journey of atherosclerosis begins with endothelial dysfunction and culminates into its most fearful destination producing ischemia, myocardial infarction and death. The excess cardiovascular disease morbidity and mortality in African-Americans is one of the major public health problems. In this review, we discuss vascular endothelial dysfunction as a key element for excess cardiovascular disease burden in this target population. It can be logical window of future atherosclerotic outcomes, and further efforts should be made to detect it at the earliest in African American individuals even if they are appearing healthy as the therapeutic interventions if instituted early, might prevent the subsequent cardiac events.
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Kubala L, Lu G, Baldus S, Berglund L, Eiserich JP. Plasma levels of myeloperoxidase are not elevated in patients with stable coronary artery disease. Clin Chim Acta 2008; 394:59-62. [PMID: 18440308 DOI: 10.1016/j.cca.2008.04.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Revised: 04/01/2008] [Accepted: 04/01/2008] [Indexed: 12/30/2022]
Abstract
BACKGROUND Plasma and serum levels of myeloperoxidase (MPO), a redox-active hemoprotein released by polymorphonuclear neutrophils (PMN) upon activation, is now recognized as a powerful prognostic determinant of myocardial infarction in patients suffering acute coronary syndromes. However, there is limited information on whether systemic MPO levels are also elevated and of discriminating value in patients with stable coronary artery disease (CAD) representing different ethnic groups. METHODS Plasma levels of MPO and traditional CAD risk factors were quantified in African American and Caucasian patients (n=557) undergoing elective coronary angiography. RESULTS MPO levels did not differ significantly between patients with or without CAD [421 pM (321, 533) vs. 412 pM (326, 500), p>0.05]. MPO levels were similar across ethnicity and gender, and correlated positively with CRP and fibrinogen levels (r=0.132, p=0.002 and r=0.106, p=0.011, respectively). CONCLUSION In conclusion, plasma MPO levels were not elevated in patients with stable CAD, suggesting that systemic release of MPO is not a characteristic feature of asymptomatic CAD.
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Affiliation(s)
- Lukas Kubala
- Department of Internal Medicine, Division of Nephrology, University of California, Davis, CA, USA.
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Anuurad E, Rubin J, Chiem A, Tracy RP, Pearson TA, Berglund L. High levels of inflammatory biomarkers are associated with increased allele-specific apolipoprotein(a) levels in African-Americans. J Clin Endocrinol Metab 2008; 93:1482-8. [PMID: 18252779 PMCID: PMC2291489 DOI: 10.1210/jc.2007-2416] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND A role of inflammation for cardiovascular disease (CVD) is established. Lipoprotein(a) [Lp(a)] is an independent CVD risk factor where plasma levels are determined by the apolipoprotein(a) [apo(a)] gene, which contains inflammatory response elements. DESIGN We investigated the effect of inflammation on allele-specific apo(a) levels in African-Americans and Caucasians. We determined Lp(a) levels, apo(a) sizes, allele-specific apo(a) levels, fibrinogen and C-reactive protein (CRP) levels in 167 African-Americans and 259 Caucasians. RESULTS Lp(a) levels were increased among African-Americans with higher vs. lower levels of CRP [<3 vs. > or =3 mg/liter (143 vs. 108 nmol/liter), P = 0.009] or fibrinogen (<340 vs. > or =340 mg/liter, P = 0.002). We next analyzed allele-specific apo(a) levels for different apo(a) sizes. No differences in allele-specific apo(a) levels across CRP or fibrinogen groups were seen among African-Americans or Caucasians for small apo(a) sizes (<22 kringle 4 repeats). Allele-specific apo(a) levels for medium apo(a) sizes (22-30 kringle 4 repeats) were significantly higher among African-Americans, with high levels of CRP or fibrinogen compared with those with low levels (88 vs. 67 nmol/liter, P = 0.014, and 91 vs. 59 nmol/liter, P < 0.0001, respectively). No difference was found for Caucasians. CONCLUSIONS Increased levels of CRP or fibrinogen are associated with higher allele-specific medium-sized apo(a) levels in African-Americans but not in Caucasians. These findings indicate that proinflammatory conditions result in a selective increase in medium-sized apo(a) levels in African-Americans and suggest that inflammation-associated events may contribute to the interethnic difference in Lp(a) levels between African-Americans and Caucasians.
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Affiliation(s)
- Erdembileg Anuurad
- Department of Medicine, University of California, Davis, Sacramento, California 95817, USA
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Liao YC, Lin HF, Rundek T, Cheng R, Hsi E, Sacco RL, Juo SHH. Multiple genetic determinants of plasma lipid levels in Caribbean Hispanics. Clin Biochem 2007; 41:306-12. [PMID: 18078817 DOI: 10.1016/j.clinbiochem.2007.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Revised: 11/17/2007] [Accepted: 11/19/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To identify candidate genes in relation to plasma lipid levels in Caribbean Hispanics. DESIGN AND METHODS A total of 114 single nucleotide polymorphisms (SNPs) at 17 lipid-related genes were genotyped in 477 Caribbean Hispanics from the Northern Manhattan Study (NOMAS). Analyses for each SNP and haplotype were performed to evaluate the associations with four lipid traits: high- and low-density lipoprotein cholesterol (HDL-C, LDL-C), triglyceride (TG) and total cholesterol (TC). RESULTS We identified 19 SNPs at 10 genes that were significantly related to lipids (p<0.01), including nine involved in the reverse cholesterol transport pathway, and one involved in bile acid synthesis. Three genes, namely the apolipoprotein A5, apolipoprotein B and cytochrome p450 polypeptide 7A1 genes, accounted for the largest proportion of variation in HDL-C/TG, TC and LDL-C respectively. CONCLUSIONS The cumulative effects of multiple genetic variants led to a substantially better prediction of inter-individual variations in lipid levels.
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Affiliation(s)
- Yi-Chu Liao
- Graduate Institute of Medical Genetics, Kaohsiung Medical University, Kaohsiung, Taiwan
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Baldo G, Giunco S, Kontothanassis D, Baiocchi MR, Valerio A, Frego M. Different apoprotein(a) isoform proportions in serum and carotid plaque. Atherosclerosis 2007; 193:177-85. [PMID: 16839560 DOI: 10.1016/j.atherosclerosis.2006.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Revised: 05/24/2006] [Accepted: 06/02/2006] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Cardio- and/or cerebro-vascular risk are associated with high lipoprotein (a) [Lp(a)] levels and low-molecular-weight (LMW) apo(a) isoforms. Aims of this study were to evaluate the deposition of apo(a) isoforms and apoprotein B (apo B) in atherosclerotic plaque from patients (males and females) who had carotid endarterectomy for severe stenosis, and to identify differences between patients classified by gender and divided according to the stability or instability of their plaques. MATERIALS AND METHODS We determined lipids, apo B and Lp(a) in serum and plaque extracts from 55 males and 25 females. Apo(a) was phenotyped and isoforms were classified by number of kringle IV (KIV) repeats. RESULTS Lp(a) levels were higher in female serum and plaque extracts than in male samples, while apo B levels were lower. More Lp(a) than apo B deposition was observed in plaque after normalization for serum levels. Thirty-one different apo(a) isoforms were detected in our patients, with a double band phenotype in 94% of cases. In both sexes, the low/high (L/H) molecular weight apo(a) isoform expression ratio was significantly higher in plaque than in serum. Females with unstable plaques had higher Lp(a) levels in both serum and tissue extracts, and fewer KIV repeats of the principal apo(a) isoform in the serum than the other female group or males. CONCLUSIONS In both sexes, the same apo(a) isoforms are found in serum and atherosclerotic plaque, but in different proportions: in plaque, LMW apo(a) is almost always more strongly accumulated than HMW apo(a), irrespective of any combination of apo(a) isoforms in double band phenotypes or Lp(a) serum levels. Moreover, serum and tissue Lp(a) levels were higher in females than in males, and particularly in the group with unstable plaques.
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Affiliation(s)
- Goretta Baldo
- Department of Medical and Surgical Sciences, University of Padua, Italy.
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Lu G, Chiem A, Anuurad E, Havel PJ, Pearson TA, Ormsby B, Berglund L. Adiponectin levels are associated with coronary artery disease across Caucasian and African-American ethnicity. Transl Res 2007; 149:317-23. [PMID: 17543850 DOI: 10.1016/j.trsl.2006.12.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2006] [Revised: 11/28/2006] [Accepted: 12/01/2006] [Indexed: 11/17/2022]
Abstract
The hypothesis was tested that plasma levels of adiponectin would be associated with coronary artery disease (CAD) across African-American and Caucasian ethnicity and gender. Adiponectin levels, cardiovascular risk factors, and extent of CAD were measured in 453 subjects (173 African-American and 280 Caucasian men and women). The distribution of adiponectin levels differed significantly between African-Americans and Caucasians (P<0.0001). Among African-Americans, the adiponectin distribution was skewed toward lower levels. For women, adiponectin levels were higher among Caucasians compared with African-Americans (P<0.001), whereas no interethnic difference was observed for men. Irrespective of ethnic group, subjects with CAD had lower levels of adiponectin than did subjects without CAD. Adiponectin was negatively and significantly associated with waist-hip ratio, body mass index, diastolic blood pressure, insulin level, and homeostasis model assessment-insulin resistance in both ethnic groups. Among lipid parameters, total cholesterol, triglyceride, and low-density lipoprotein cholesterol levels were negatively correlated with adiponectin, whereas the high-density lipoprotein cholesterol level correlated positively for both African-Americans and Caucasians. In a multiple regression model, controlling for gender, ethnicity, and other CAD risk factors, adiponectin levels were negatively associated with CAD (P<0.05). The results indicate that, across gender and ethnicity, low adiponectin levels may be an independent risk factor for CAD.
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Affiliation(s)
- Guijing Lu
- Department of Medicine, University of California-Davis, USA, and Department of Medicine, Xiangya Hospital of Xiangya Medical School, Central South University, Changsha, P. R. China
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Kloska SP, Schlegel PM, Sträter R, Niederstadt TU. Causality of pediatric brainstem infarction and basilar artery fenestration? Pediatr Neurol 2006; 35:436-8. [PMID: 17138016 DOI: 10.1016/j.pediatrneurol.2006.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Revised: 05/18/2006] [Accepted: 06/19/2006] [Indexed: 11/23/2022]
Abstract
Pediatric arterial thromboembolic stroke is an uncommon condition and rarely is reported to be associated with a cerebral artery fenestration. This clinical report discusses the case of a child with brainstem infarction and basilar artery fenestration. A cardiac source of thromboembolic events could be excluded; however, detailed coagulation analysis revealed in addition an apoliopoprotein(a) size polymorphism. Because we assume that the two concurrent pathologies in combination caused the arterial thromboembolic stroke, the evaluation of all potential triggers including vascular anomalies and coagulation disorders should be considered in unexplained pediatric infarction.
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Affiliation(s)
- Stephan P Kloska
- Department of Clinical Radiology, University of Muenster, Muenster, Germany.
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Anuurad E, Boffa MB, Koschinsky ML, Berglund L. Lipoprotein(a): A Unique Risk Factor for Cardiovascular Disease. Clin Lab Med 2006; 26:751-72. [PMID: 17110238 DOI: 10.1016/j.cll.2006.07.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Lipoprotein(a) (Lp(a)) is present in humans and primates. It has many properties in common with low-density lipoprotein, but contains a unique protein moiety designated apo(a), which is linked to apolipoprotein B-100 by a single disulfide bond. International standards for Lp(a) measurement and optimized Lp(a) assays insensitive to isoform size are not yet widely available. Lp(a) is a risk factor for coronary artery disease, and smaller size apo(a) is associated with coronary artery disease. The physiologic role of Lp(a) is unknown.
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Affiliation(s)
- Erdembileg Anuurad
- Department of Medicine, VA Northern California Health Care System, UCD Medical Center, University of California-Davis, 4150 V Street, Suite G400, Sacramento, CA 95817, USA
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Discepolo W, Wun T, Berglund L. Lipoprotein(a) and Thrombocytes: Potential Mechanisms Underlying Cardiovascular Risk. PATHOPHYSIOLOGY OF HAEMOSTASIS AND THROMBOSIS 2006; 35:314-21. [PMID: 16877880 DOI: 10.1159/000093224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Plasma levels of lipoprotein(a), Lp(a), is an independent risk factor for cardiovascular disease. Lp(a) has many properties in common with low-density lipoprotein (LDL), including a cholesteryl ester-rich lipid core and the presence of one copy of apolipoprotein B-100; both apoB-100 and the lipid core are pro-atherogenic. In addition, Lp(a) contains a unique hydrophilic, carbohydrate-rich protein, apo(a), linked to apoB through a single disulfide bond connecting the C-terminal regions of the two proteins. The similarities between apolipoprotein(a), apo(a), and plasminogen has initiated numerous studies on the possible role of Lp(a) as a prothrombotic agent. Studies to date suggest that Lp(a) has antifibrinolytic and procoagulant properties. In this review, we summarize recent studies focused on the interaction between Lp(a) and platelets. Collectively, results to date illustrate that thrombogenicity associated with Lp(a) could be due to risk associated with the LDL moiety, with the apo(a) moiety, or from the combination of those in Lp(a). Present findings suggest that the various components of Lp(a) may impact to a varying degree on different underlying pathways involved in platelet activation and aggregation. On balance, results indicate an effect by Lp(a) on platelet function and future studies focused on specific Lp(a) components, such as the role of apo(a) and of the LDL-like lipid moiety, are needed.
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Zídková K, Kebrdlová V, Zlatohlávek L, Ceska R. Detection of variability in apo(a) gene transcription regulatory sequences using the DGGE method. Clin Chim Acta 2006; 376:77-81. [PMID: 16916503 DOI: 10.1016/j.cca.2006.07.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2006] [Revised: 07/17/2006] [Accepted: 07/17/2006] [Indexed: 11/27/2022]
Abstract
BACKGROUND Increased lipoprotein(a), Lp(a), concentration is an independent risk factor for premature atherosclerosis. Apolipoprotein(a), apo(a), determines properties of the lipoprotein and its production rate is the limiting step in Lp(a) particle formation. METHODS Subjects covering the whole range of Lp(a) concentration were separated into quintiles. A randomly chosen sample from each quintile was derived, there being a total number of 713 individuals. The DGGE method was used to scan the known transcription regulatory regions of apo(a) gene (promoter; DHII and DHIII enhancers) for variability and its distribution across quintiles. RESULTS Besides 5 previously reported nucleotide substitutions (+121 G>A; +93 C>T; -1712 G>T; -1617 C>A; -1230 A>G) 16 unreported rare sequence variants were detected. All polymorphic variants were distributed throughout the quintiles with several significant differences. The novel +62 C variant was found only among individuals with Lp(a) levels over 16 mg/dl. CONCLUSION The apo(a) gene transcription regulatory regions were not revealed to be extremely polymorphic. However, we should consider a combined effect of all polymorphic sites from the whole apo(a) gene locus, including the apo(a) gene length polymorphism, when dealing with high population variability of Lp(a) levels.
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Affiliation(s)
- Katerina Zídková
- 3rd Medical Department, 1st Faculty of Medicine and General Teaching Hospital, Charles University in Prague, Prague 12808, Czech Republic.
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Milionis HJ, Filippatos TD, Loukas T, Bairaktari ET, Tselepis AD, Elisaf MS. Serum lipoprotein(a) levels and apolipoprotein(a) isoform size and risk for first-ever acute ischaemic nonembolic stroke in elderly individuals. Atherosclerosis 2006; 187:170-6. [PMID: 16197951 DOI: 10.1016/j.atherosclerosis.2005.08.036] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2005] [Revised: 08/25/2005] [Accepted: 08/29/2005] [Indexed: 11/30/2022]
Abstract
In a population-based case-control study, we investigated the association of acute ischaemic stroke with lipoprotein(a) (Lp(a)) levels and apolipoprotein (Apo) (a) isoform size in subjects aged older than 70 years. A total of 163 patients with a first-ever-in-a-lifetime acute ischaemic/nonembolic stroke and 166 controls were included. Compared to controls, stroke patients exhibited higher Lp(a) concentrations (median value, 12.2 mg/dl versus 6.4 mg/dl, p < 0.001) and a higher frequency of small Apo(a) isoforms (44.2% versus 29.5%, p < 0.01). Multivariate logistic regression analysis showed a significant association of acute ischaemic stroke with Lp(a) levels [adjusted odds ratio (OR), 1.37, 95% CI (1.12-1.67); p = 0.002], and small Apo(a) isoform size [OR, 1.74 (1.10-3.03); p = 0.04]. Compared to subjects with Lp(a) levels in the lowest quintile, those within the highest quintile had a 3.2-times adjusted risk to suffer an acute ischaemic/nonembolic stroke (1.60-6.62, 95% CI; p < 0.001). Furthermore, analysis of interaction between lipid variables revealed that in the presence of elevated Lp(a) levels the inverse relationship between HDL-cholesterol levels and ischaemic stroke was negated [OR, 1.01 (1.00-1.03); p = 0.015]. Our study suggests that determination of Lp(a) levels and Apo(a) isoform size may be important in identifying elderly individuals at risk of ischaemic stroke independently of other risk factors and concurrent metabolic derangements.
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Affiliation(s)
- Haralampos J Milionis
- Department of Internal Medicine, Medical School, University of Ioannina, 451 10 Ioannina, Greece.
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Enas EA, Chacko V, Senthilkumar A, Puthumana N, Mohan V. Elevated lipoprotein(a)--a genetic risk factor for premature vascular disease in people with and without standard risk factors: a review. Dis Mon 2006; 52:5-50. [PMID: 16549089 DOI: 10.1016/j.disamonth.2006.01.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Enas A Enas
- CADI Research Foundation, Lisle, Illinois, USA
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Koschinsky ML. Lipoprotein(a) and atherosclerosis: new perspectives on the mechanism of action of an enigmatic lipoprotein. Curr Atheroscler Rep 2006; 7:389-95. [PMID: 16105483 DOI: 10.1007/s11883-005-0052-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Although elevated plasma concentrations of lipoprotein(a) (Lp(a)) have been identified as a risk factor for coronary heart disease, the pathophysiologic and physiologic roles of Lp(a) continue to elude basic researchers and clinicians alike. Lp(a) is a challenging lipoprotein to study because it has a complex structure consisting of a low-density lipoprotein-like moiety to which is covalently attached the unique glycoprotein apolipoprotein(a) (apo(a)). Apo(a) contains multiply repeated kringle domains that are similar to a sequence found in the fibrinolytic proenzyme plasminogen; differing numbers of kringle sequences in apo(a) give rise to Lp(a) isoform size heterogeneity. In addition to elevated plasma concentrations of Lp(a), apo(a) isoform size has been identified as a risk factor for coronary heart disease, although studies addressing this relationship have been limited. The similarity of Lp(a) to low-density lipoprotein and plasminogen provides an enticing link between the processes of atherosclerosis and thrombosis, although a clear demonstration of this association in vivo has not been provided. Clearly, Lp(a) is a risk factor for both atherothrombotic and purely thrombotic events; a plethora of mechanisms to explain these clinical findings has been provided by both in vitro studies as well as animal models for Lp(a).
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Affiliation(s)
- Marlys L Koschinsky
- Department of Biochemistry, Queen's University, A208 Botterell Hall, Kingston, ON K7L 3N6, Canada.
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Abstract
Lipoprotein (a) [Lp(a)], is present only in humans, Old World nonhuman primates, and the European hedgehog. Lp(a) has many properties in common with low-density lipoprotein (LDL) but contains a unique protein, apo(a), which is structurally different from other apolipoproteins. The size of the apo(a) gene is highly variable, resulting in the protein molecular weight ranging from 300 to 800 kDa; this large variation may be caused by neutral evolution in the absence of any selection advantage. Apo(a) influences to a major extent metabolic and physicochemical properties of Lp(a), and the size polymorphism of the apo(a) gene contributes to the pronounced heterogeneity of Lp(a). There is an inverse relationship between apo(a) size and Lp(a) levels; however, this pattern is complex. For a given apo(a) size, there is a considerable variation in Lp(a) levels across individuals, underscoring the importance to assess allele-specific Lp(a) levels. Further, Lp(a) levels differ between populations, and blacks have generally higher levels than Asians and whites, adjusting for apo(a) sizes. In addition to the apo(a) size polymorphism, an upstream pentanucleotide repeat (TTTTA(n)) affects Lp(a) levels. Several meta-analyses have provided support for an association between Lp(a) and coronary artery disease, and the levels of Lp(a) carried in particles with smaller size apo(a) isoforms are associated with cardiovascular disease or with preclinical vascular changes. Further, there is an interaction between Lp(a) and other risk factors for cardiovascular disease. The physiological role of Lp(a) is unknown, although a majority of studies implicate Lp(a) as a risk factor.
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Affiliation(s)
- Lars Berglund
- Department of Medicine, University of California, Davis, UCD Medical Center, 4150 V Street, Suite G400, Sacramento, CA 95817, USA.
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Wu HD, Berglund L, Dimayuga C, Jones J, Sciacca RR, Di Tullio MR, Homma S. High lipoprotein(a) levels and small apolipoprotein(a) sizes are associated with endothelial dysfunction in a multiethnic cohort. J Am Coll Cardiol 2004; 43:1828-33. [PMID: 15145108 DOI: 10.1016/j.jacc.2003.08.066] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2003] [Revised: 08/08/2003] [Accepted: 08/18/2003] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study sought to determine the effect of lipoprotein(a), or Lp(a), levels and apolipoprotein(a), or apo(a), sizes on endothelial function and to explore ethnic differences in their effects. BACKGROUND Although high levels of Lp(a) have been shown to confer increased cardiovascular risk in Caucasians, its significance in non-Caucasian populations is uncertain. The pathogenic role of the apo(a) component of Lp(a) is also unclear. METHODS The relationship of Lp(a) levels and apo(a) sizes to endothelial function was examined in a multiethnic cohort of 89 healthy subjects (age 42 +/- 9 years; 50 men, 39 women) free of other cardiac risk factors. Endothelium-dependent, flow-mediated dilation (FMD) and endothelium-independent, nitrate-induced dilation (NTG) were assessed by ultrasound imaging of the brachial artery. RESULTS Plasma Lp(a) levels were lowest in Caucasians (18.3 +/- 21.1 mg/dl, n = 40); intermediate in Hispanics (30.2 +/- 30.5 mg/dl, n = 21); and highest in African Americans (68.8 +/- 46.0 mg/dl, n = 28). Lipoprotein(a) levels were found to correlate inversely to FMD (r = -0.33, p < 0.005) but not to NTG (r = 0.06, p = 0.60). This association remained significant after adjusting for gender (p = 0.002). In addition, subjects with small apo(a) size of <or=22 kringle 4 repeats had significantly lower FMD than those with large apo(a) (2.23 +/- 2.37% vs. 6.26 +/- 4.29%, p < 0.0001), irrespective of Lp(a) levels. CONCLUSIONS These findings support an independent role of Lp(a) in atherogenesis, an effect that is particularly evident in African Americans. The proatherogenic property of Lp(a) can be attributed in part to its apo(a) component.
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Affiliation(s)
- Henry D Wu
- Department of Medicine, Columbia University, New York, New York 10032, USA.
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Alaoui M, Merle C, Garnotel R, Jolly D, Durlach V, Gillery P. Study of apo(a) length polymorphism and lipoprotein(a) concentrations in subjects with single or double apo(a) isoforms. Clin Chem Lab Med 2003; 41:634-9. [PMID: 12812260 DOI: 10.1515/cclm.2003.096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cardiovascular risk is associated with high lipoprotein(a) (Lp(a)) concentrations and low molecular weight apolipoprotein(a) (apo(a)) isoforms. We studied the relationship between these two biological parameters, particularly in subjects expressing two apo(a) isoforms. Plasma Lp(a) was measured by immunonephelometry in 530 unrelated Caucasian patients at high cardiovascular risk, and apo(a) size determined by immunoblotting using a recombinant standard. Two, one, or no apo(a) isoforms were detected in 258, 270, and 2 subjects, respectively. Lp(a) concentrations showed a non-Gaussian distribution, being higher in the 'double band' than in the 'single band' group (median 0.42 vs. 0.11 g/l, p < 0.0005). Apo(a) size distribution was bimodal, with two frequency peaks at 18 kringles (K) and 27 K. Small size apo(a) isoforms were more frequently found in the 'double band' group, where major isoforms were of lower size than minor isoforms (median 20 vs. 27 K). Regression analysis showed that apo(a) gene length accounted for 33% of Lp(a) variation, with a threshold effect at 20 K, no correlation being found over this value. The minor apo(a) isoform did not significantly influence Lp(a) concentration. These data confirm the relationship between apo(a) size and Lp(a) concentration and suggest that the assessment of cardiovascular risk should take into account the threshold effect at 20 K and the absence of influence of the minor apo(a) isoform.
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Affiliation(s)
- Mariam Alaoui
- Laboratory of Biochemistry, Robert Debré Hospital, CHU of Reims, Reims, France
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Xiong ZW, Wahlqvist ML, Wattanapenpaiboon NT, Biegler BM, Balazs NDH, Xiong DW, Lim YL. Factors contributing to variation in lipoprotein (a) in Melbourne Anglo-Celtic population. Eur J Clin Nutr 2003; 57:447-54. [PMID: 12627182 DOI: 10.1038/sj.ejcn.1601562] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2001] [Revised: 05/17/2002] [Accepted: 06/18/2002] [Indexed: 11/09/2022]
Abstract
AIM The purpose of this report is to survey the factors contributing to variation in lipoprotein(a) (Lp(a)) in a population-based sample of Anglo-Celtic Melburnians. RESULTS The plasma Lp(a) levels were highly skewed towards low levels in this population, with a median of 156 mg/l and a mean of 262 mg/l. Approximately 33% had plasma Lp(a) above the threshold value of 300 mg/l, while 35% had Lp(a) levels below 100 mg/l. The most commonly occurring phenotype was apo(a) S3. In this phenotype, Lp(a) concentrations ranged from 10 to 596 mg/l. Lp(a) was consistently associated with diastolic blood pressure, systolic blood pressure, total protein, albumin and nitrogen excretion in the 40-60 y age group. Multiple stepwise regression analyses, in non-dietary factors, were used to explain about 13% of the variance in Lp(a) (19% in men and 23% in women). Remarkably, in the <40 y age group, non-dietary factors may account for 86% of the variance in Lp(a) and dietary factors, analysed separately, 46%. Thus, although Lp(a) is mainly genetically determined, there are clearly other factors which contribute to variations in Lp(a) concentrations.
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Scanu AM. Lipoprotein(a) and the atherothrombotic process: mechanistic insights and clinical implications. Curr Atheroscler Rep 2003; 5:106-13. [PMID: 12573195 DOI: 10.1007/s11883-003-0081-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although many epidemiologic studies have pointed at an association between plasma levels of lipoprotein(a) (Lp(a)) and cardiovascular risk, the data obtained have been conflicting because of a number of factors, particularly those dealing with plasma storage, lack of assay standardization, population sample size, age, gender, ethnic variations, and variable disease endpoints. Moreover, the attention has been primarily focused on whole Lp(a), with relatively less emphasis on its constituent apolipoprotein(a) and on the apolipoprotein B100-containing lipoprotein, mainly low-density lipoprotein (LDL), to which apolipoprotein(a) is linked. According to recent studies, small-size apolipoprotein(a) isoforms may represent a cardiovascular risk factor either by themselves or synergistically with plasma Lp(a) concentration. Moreover, the density properties of the LDL moiety may have an impact on Lp(a) pathogenicity. It has also become apparent that Lp(a) can be modified by oxidative events and by the action of lipolytic and proteolytic enzymes with the generation of products that exhibit atherothrombogenic potential. The role of the O-glycans linked to the inter-kringle linkers of apolipoprotein(a) is also emerging. This information is raising the awareness of the pleiotropic functions of Lp(a) and is opening new vistas on pathogenetic mechanisms whose knowledge is essential for developing rational therapies against this complex cardiovascular pathogen.
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Affiliation(s)
- Angelo M Scanu
- Cardiology Section, Department of Medicine and Biochemistry and Molecular Biology, MC5041, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA.
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Le NA. Hyperlipidaemia and cardiovascular disease. Curr Opin Lipidol 2002; 13:577-80. [PMID: 12352022 DOI: 10.1097/00041433-200210000-00015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW Lipoprotein(a) belongs to the class of the most atherogenic lipoproteins. Despite intensive research - in the last year more than 80 papers have been published on this topic - information is still lacking on the physiological function of lipoprotein(a) and the site of its catabolism. Important advances have been made in the knowledge of these points, which may have some therapeutic implications. RECENT FINDINGS The association of high lipoprotein(a) values with an increase in risk for coronary events has been documented in further prospective studies. This increased risk may relate to recent findings that apolipoprotein(a) is produced in situ within the vessel wall. In addition, lipoprotein(a) binds and inactivates the tissue factor pathway inhibitor and induces plasminogen activator inhibitor type 2 expression in monocytes. A new antisense oligonucleotide strategy has been proposed which efficiently inhibits apolipoprotein(a) expression in vitro and in vivo. Apolipoprotein(a), however, suppresses angiogenesis and thus may interfere with the infiltration of tumor cells. Finally, the enzymatic activity leading to the formation of apolipoprotein(a) fragments in plasma and their catabolism have been further elucidated. SUMMARY We are still far away from understanding the pathways involved in lipoprotein(a) catabolism, and the physiological function of this lipoprotein. Recent findings, however, provide new insight into pathomechanisms in patients with increased lipoprotein(a) related to hemostasis, which may serve as a basis for designing new treatment strategies.
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Affiliation(s)
- Karam M Kostner
- Department of Cardiology, University Hospital of Vienna, Austria
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