Lipoprotein (a) and its relationship to risk factors and severity of atherosclerotic peripheral vascular disease

Objectives: To determine the significance of Lipoprotein (a) (Lp(a)) as a risk factor for atherosclerotic lower limb peripheral vascular disease (PVD), and its relationship to other demographic and biochemical variables and disease pattern and severity. Design: Prospective case-control study. Material and methods: Demographic and biochemical risk factors, lipoprotein fractions and Lp(a) were measured in 200 patients and PVD and 200 age- and sex-matched control subjects. Lp(a) levels were correlated with traditional risk factors and clinical and vascular laboratory disease parameters. Results: Patients with PVD have a higher incidence of smoking, hypertension, and diabetes mellitus; and had significantly higher levels of serum cholesterol, triglycerides, LDL, VLDL, apolipoprotein B, fasting glucose, fibrinogen, plasminogen, haematocrit, white cell and platelet counts; but lower levels of HDL and apolipoprotein A1. Fasting Lp(a) concentration is an independent risk factor for PVD and is significantly higher in the patients (median=26.1 mg/dl [4.8-195], mean=36.5+/-32.6 mg/dl) than in controls (median=18.2 mg/dl [5.4-216], mean=27.2+/-28.1 mg/dl; p<0.0001). In patients with PVD, Lp(a) correlated positively with plasma LDL, cholesterol, fibrinogen, renal disease, and apolipoprotein B. Fasting levels of >24 mg/dl incurred a two-fold increase in risk of PVD. Patients with a higher Lp(a) have a significantly higher incidence of resting pain and ulcerations, and regression analysis confirmed smoking and Lp(a) level to be associated with the SVS category of disease severity. Conclusions: Lipoprotein (a) is a significant independent risk factor for PVD. Lp(a) levels correlated with LDL, cholesterol, fibrinogen, apolipoprotein B and disease severity. An elevated Lp(a) level may be associated with more severe forms of PVD.