The correlation between lipoprotein(a) and coronary atherosclerotic lesion is stronger than LDL-C, when LDL-C is less than 104 mg/dL

Abstract

Background Lp(a) and LDL-C are both risk factors of atherosclerotic cardiovascular disease (ASCVD). But there was a contradiction point in LDL-C and Lp(a) control. The appropriate level of LDL-C and Lp(a) in the prevention of ASCVD is still pending. Objective To investigate the correlation of Lp(a) and coronary atherosclerotic lesion, and find out the balance point in LDL-C and Lp(a) control. Method 3449 patients were divided to coronary atherosclerotic heart disease (CAHD) Group and Non-CAHD Group based on the result of coronary angiography. The clinical characteristics were compared, and Logistic regressions were applied to find the CAHD risk factors in total, High-LDL-C Group (LDL-C ≥ 100 mg/dL) and Low-LDL-C Group (LDL-C < 100 mg/dL) patients. Spearman correlation analysis of Lp(a), LDL-C and Gensini Score was performed in patients with different LDL-C concentration. Results Except male and diabetes, the traditional CAHD risk factors were well matched between two groups. But triglyceride, LDL-C and Lp(a) were higher, HDL-C and Apo-A1 were lower in CAHD group (2771). In the Logistic regression analysis, diabetes, LDL-C and Lp(a) are risk factors of CAHD in all patients, while in High-LDL-C Group, they were age, LDL-C, non-HDL-C and ApoB, in Low-LDL-C Group, they were age, Lp(a) and ApoB. Lp(a) correlated with Gensini with coefficient r = 0.41 in all patients, 0.67 in Low-LDL-C Group and 0.32 in High-LDL-C Group. The coefficient r for Lp(a) and Gensini decreased, while the r for LDL-C and Gensini increased with LDL-C concentration increasing. The two fitted lines of rs crossed at LDL-C = 2.7 mmol/L (104 mg/dL). Conclusion Lp(a) was the risk factor of CAHD in patients with LDL-C < 100 mg/dL. The correlation between Lp(a) and Gensini was influenced by LDL-C concentration, and the correlation was stronger than LDL-C when LDL-C < 104 mg/dl.

Lipoprotein(a): a risk factor for atherosclerosis and an emerging therapeutic target

“…In patients treated with high-efficacy statins who achieved very low LDL-C levels in the primary prevention setting, Lp(a) levels were found to be a determinant of residual ASCVD risk 8. A correlation between Lp(a) levels and coronary heart disease (CHD) has been found in patients with low LDL-C (<104 mg/dL) 9. Overall, available evidence shows that Lp(a) is an ASCVD risk factor independent of LDL-C levels 10 11.…”

Clinical Values and Underlying Mechanism Analysis of Serum miR-455-5p in Carotid Artery Stenosis

“…LDL binds to free cholesterol in the blood and can be oxidized to oxidized LDL (ox-LDL), which can promote macrophages to become foam cells, leading to the formation of atherosclerosis. 20 In the current study, after adjusting for other clinical indexes, LDL was identified to be an independent factor for the degree of CAS.…”

Elevated serum lipoprotein(a) is significantly associated with angiographic progression of coronary artery disease

“…However, a single‐center cross‐sectional study was recently conducted to investigate the association between Lp(a) and coronary atherosclerotic lesion using Gensini score, Li et al found the association was influenced by LDL‐C levels. They revealed that Lp(a) was the risk factors of coronary atherosclerotic heart disease in patients with LDL‐C<100 mg/dl 27 . Therefore, the evaluation of Lp(a) in patients with well controlled cholesterol remained to be further studied.…”