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Malignant coronary artery disease (CAD) refers to a severe and extensive atherosclerotic process involving multiple coronary arteries in young individuals (aged <45 years in men and <50 years in women) with a low or no burden of established risk factors. Indians, in general, develop acute myocardial infarction (AMI) about 10 years earlier; AMI rates are threefold to fivefold higher in young Indians than in other populations. Although established CAD risk factors have a predictive value, they do not fully account for the excessive burden of CAD in young Indians. Lipoprotein(a) (Lp(a)) is increasingly recognized as the strongest known genetic risk factor for premature CAD, with high levels observed in Indians with malignant CAD. High Lp(a) levels confer a twofold to threefold risk of CAD—a risk similar to that of established risk factors, including diabetes. South Asians have the second highest Lp(a) levels and the highest risk of AMI from the elevated levels, more than double the risk observed in people of European descent. Approximately 25% of Indians and other South Asians have elevated Lp(a) levels (≥50 mg/dl), rendering Lp(a) a risk factor of great importance, similar to or surpassing diabetes. Lp(a) measurement is ready for clinical use and should be an essential part of all CAD research in Indians.
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Objective To analyze the relationship between the serum CysC,lipoprotein(a) [Lp(a)] and the urinary microalbumin/creatinine ratio in elderly type 2 dibetic (T2CM) patients.Methods A total of 102 elderly patients with T2CM who were treated in our hospital from December 2014 to December 2015 were selected.The patients were divided into diabetic nephropathy(DN) group(mALB≥20 μg/min,48 cases)and non-diabetic nephropathy(NDN) group (mALB<20 μg/min,54 cases) according the levels of urinary mALB,while 30 cases of healthy controls were selected from physical examination center.The biochemical indexes,CysC,Lp(a) and UACR were detected among all cases.The correlation between indexes and UACR was analyzed by Pearson correlation analysis,risk factors for UACR among DN patients were analyzed by Logistic regression analysis.Results There were significant differences in levels of low density lipoprotein cholesterol(LDL-C),Lp(a),urea,creatinine,fasting blood glucose(FBG),glycosylated hemoglobin(HbA1c),Cysc,and UACR among these groups (P<0.05).No correlation between CysC、Lp(a) and UACR was found in normal-control group and non-diabetic nephropathy group.In diabetic nephropathy group,there was a positive correlation between CysC,Lp(a) and UACR(r=0.658,P<0.01;r=0.525,P<0.05).The Logistic regression analysis showed that diabetes duration,CysC,Lp(a) were independent risk factors for UACR(P<0.05).Conclusion In patients with diabetic nephropathy,CysC,Lp(a) are positively correlated with UACR,and CysC is a sensitive index that reflect early renal damage in T2DM patients.Lp(a) level is one of the independent risk factors for UACR,which can reveal the kidney damage in DN patients.
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OBJECTIVE:To observe the efficacy and safety of atorvastatin calcium combined with metoprolol in the treatment of chronic congestive heart failure (CHF). METHODS:207 CHF patients were randomly divided into control group (102 cases) and observation group (105 cases). Control group received cardiac,diuretic,vasodilating and oxygen inhalation,Metoprolol tar-trate tablet with initial dose of 6.25 mg,2-3 times a day,then increased 6.25-12.5 mg based on the improvement,2-3 times a day. Observation group additionally received 80 mg Atorvastatin tablet,twice a day. The treatment course for both groups was 16 w. Clinical efficacy,cardiac functions [left ventricular ejection fraction(LVEF),left ventricular end systolic diameter(LVESD),mi-tral early diastolic and late diastolic peak flow velocity ratio(E/A)],blood lipids [lipoprotein(a)Lp(a),triglyceride(TG),total cholesterol(TC)] levels before and after treatment,and the incidence of adverse reactions in 2 groups were observed. RESULTS:The total effective rate in observation group was significantly higher than control group,the difference was statistically significant (P0.05). Af-ter treatment,the LVEF and E/A in 2 groups were significantly higher than before,and observation group was higher than control group,LVESD,Lp(a),TG and TC were significantly lower than before,and observation group was lower than control group,the differences were statistically significant (P0.05). CONCLUSIONS:Based on conventional treatment,the efficacy of atorvastatin calcium combined with metoprolol is su-perior to metoprolol in the treatment of CHF,with better safety.
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Objective To validate the analytical performance of four LP(a)reagents with Immunoturbidimetry method used on the automatic biochemistry analyzer for preliminary clinical application.Methods The performance of four LP(a)reagents (labeled as A,B,C,D)with method from RANDOX,Zhejiang Kuake Co.,Beijing Leadman Co.and Beijing Jiuqiang Co.on Olympus AU5800 automatic biochemistry analyzer were assessed.The precision,linearity range,accuracy,disturbance (vita-min C,bilirubin,hemoglobin,TG)were assessed.Results The within-run CVs of the four reagents (A,B,C and D)were 0.64%~1.18%,3.59%~4.75%,1.33%~3.05% and 1.43%~2.01% respectively.The between-run CVs in A,B,C and D were 1.04%~1.7%,3.81%~4.93%,2.16%~4.76% and 2.33%~3.21% respectively,lower than the stated.The lin-earity range was 82~923 mg/L (r2 =0.997),130~935 mg/L (r 2 =0.996 4),120~1025 mg/L (r 2 =0.992 1)and 117~943 mg/L (r2 =0.999 5)in the four reagents,which demonstrated a sound linear correlation.For interference tests,no re-markable interferences (<±10%)of reagent A and reagent D were detected when Vitamin C≤10 mg/dl,hemoglobin≤200 mg/dl,bilirubin≤40 mg/dl and TG≤500 mg/dl.Interference of reagent B was found when VC≥5 mg/dl,TG≥250 mg/dl and when TG≥250 mg/dl reagent C was interfered significantly.The four LP(a)reagents were used to detect the lipid con-trol,and the deviations of the target value were - 8.07%,1.34%,- 8.05% and 7.38% respectively.Conclusion When used in automatic biochemical analyzer,the four LP(a)reagents showed high precision.The four reagents are all able to meet clinical test requirements,nevertheless,anti-interference capability were different.
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@#ObjectiveTo study the relevant pathogenic factors, Thromboxane B2 (TXB2), oxidized low density lipoprotein (OxLDL), lipoprotein(a) (Lp(a)), and homocysteine (Hcy), in patients with cerebral infarction and the correlation among them. Methods205 patients and 40 health persons (the control) were measured with the plasma TXB2, 6-keto-prostaglandin F1α (PGF1α) and TXB2/6-keto-PGF1α (T/6-K), OxLDL, Lp(a), Hcy within 24 h. Results and ConclusionThe levels of plasma TXB2, T/6-K，OxLDL, Lp(a), and Hcy significantly increased compared with the controls (P<0.01). OxLDL was correlated with Lp(a); TXB2 was correlated with T/6-K and Hcy; T/6-K was correlated with OxLDL, Lp（a）.
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OBJETIVO: Avaliar níveis de lipoproteína(a) em pacientes com síndrome antifosfolípide primária (SAFP) e suas possíveis associações clínicas e laboratoriais. MÉTODOS: Estudo transversal de 46 pacientes (93,5 por cento do sexo feminino) com SAFP (critérios de Sapporo). Foram avaliados os dados demográficos e clínicos, medicações, anticorpos antifosfolípides, além da medida dos níveis séricos em jejum da lipoproteína(a). RESULTADOS: Os níveis de lipoproteína(a) ( > 30 mg/dL) foram vistos em 43,5 por cento dos pacientes com SAFP, com média de 42 ± 43,5 mg/dL. Comparando-se o grupo com níveis maiores que 30 mg/dL com o grupo de pacientes com níveis menores ou iguais a este valor, não foram observadas diferenças significativas em relação a dados demográficos (idade, sexo, cor branca, peso, altura e índice de massa corporal), manifestações da doença (eventos arteriais, venosos, obstétricos, plaquetopenia), eventos cardiovasculares (infarto agudo do miocárdio, angina, acidente vascular cerebral), comorbidades, estilo de vida (atividade física, tabagismo atual e pregresso), uso de medicações (corticoide atual e pregresso, estatina, cloroquina), bem como à frequência de positividade de anticorpos antifosfolípides. CONCLUSÃO: Pacientes com SAFP apresentam uma frequência elevada de níveis aumentados de lipoproteína(a). Entretanto, nenhuma associação dessa anormalidade com as variáveis clínicas e laboratoriais estudadas foi encontrada.
OBJECTIVE: To evaluate levels of lipoprotein(a) in patients with primary antiphospholipid syndrome (PAPS) and its possible associations with clinical and laboratory features. METHODS: Transversal study with 46 (93.5 percent female) PAPS patients (Sapporo criteria). Demographic, clinical, drugs use, and antiphospholipid antibodies data were evaluated, as well as measurements of lipoprotein(a) serum fasting levels. RESULTS: Elevated levels of lipoprotein(a) ( > 30 mg/dL) were observed in 43.5 percent of PAPS patients, with a mean of 42 ± 43.5 mg/dL. A comparison between patients with lipoprotein(a) higher than 30 mg/dL and those with < 30 mg/dL did not show any differences regarding demographics (age, gender, white race, weight, height, body mass index), diseases features (arterial, venous or obstetric events, thrombocytopenia), cardiovascular manifestations (acute myocardial infarct, angina, stroke), comorbidities, life style (physical activity, smoking), drugs use (corticosteroids, statins, chloroquine), as well as the frequency of positivity of antiphospholipid antibodies. CONCLUSION: PAPS patients had a high frequency of increased levels of lipoprotein(a), however there was no association of this abnormality with the clinical and laboratorial features herein studied.
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Humans , Male , Female , Adolescent , Adult , Middle Aged , Antibodies, Antiphospholipid , Antiphospholipid Syndrome , Lipoprotein(a)ABSTRACT
Con el objetivo de investigar la función que ejerce la lipoproteína (a) como factor de riesgo independiente en diferentes procesos cardiovasculares se determinaron los valores de la misma en 50 sujetos sin enfermedad arterial coronaria y en 92 pacientes isquémicos. Se determinaron las concentraciones de colesterol total, HDL, LDL, triglicéridos y VLDL. Aunque las concentraciones promedio de Lp(a) fueron superiores en los pacientes que en los controles, sólo se obtuvo diferencias significativas para el grupo angina (p=0,036*). Los factores de riesgo adicionales que mostraron valores patológicos fueron el colesterol total, las LDL, HDL y los triglicéridos con diferencias significativas para los 2 primeros de p < 0,05 y p < 0,01. Se concluyó que en nuestro estudio, la lipoproteína (a) constituyó un factor de riesgo independiente de enfermedad cardiovascular por lo que su determinación debe ser incluída en las prácticas clínicas.
In order to investigate the function of lipoprotein (a) as an independent risk factor in different cardiovascular processes, its values were determined in 50 subjects with no coronary arterial disease and in 92 ischemic patients. The concentrations of total cholesterol, HDL, LDL, triglycerides and VLDL were determined. Though the average concentrations of Lp(a) were higher in patients than in controls, significant differences were only obtained for the angina group (p=0.0368*). The aditional risk factors showing pathological values were total cholesterol, LDL, HDL and triglycerides with marked differences for the first two of p<0.05 and p<0.01. It was concluded that in our study lipoprotein(a) was a risk factor independent of cardiovascular disease. Therefore, its determination should be included in the clinical practices.
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Lp (a) and coronary artery calcification (CAC) have recently been reported as predictors of plaque instability, but this is surrounded by much controversy. We investigated the influence of Lp (a) and CAC compared other acute coronary syndrome (ACS) risk factors. 698 patients diagnosed with at least minimal coronary artery obstructive disease from a coronary angiography were randomly selected using SPSS. Lp (a), other lipid profiles and past histories were checked, and CAC semi quantitatively graded on stored fluoroscopic images. The prevalence of CAC was significantly higher in the ACS than the non-ACS group (38.0% vs. 29.9%, p=0.026). The serum level of Lp (a) (26.89 +/- 30.64 vs. 20.85 +/- 21.63, p 35 mg/dl) was higher in the ACS group (24% vs. 15.7%, p 35 mg/dl. In the younger patients ( 60 years), CAC, but not the Lp (a), was an independent risk factor (OR=1.775, p=0.021, 95% CI; 1.090 - 2.890). Both the Lp (a) and CAC were risk factors for ACS, and they had a synergistic effect on its development. In the younger Lp (a), and the older CAC, was the more potent risk factor for ACS, respectively.
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Aged , Female , Humans , Male , Middle Aged , Acute Disease , Age Factors , Aging/blood , Calcinosis/blood , Coronary Artery Disease/blood , Coronary Vessels/pathology , Lipoprotein(a)/blood , Metabolic Diseases/complications , Risk Factors , SyndromeABSTRACT
Objective To evaluate an agarose gel electrophoresis for quantitative determination of Lipoprotein(a) cholesterol and its clinical application.Methods Quantification of LP(a)-C was performed by a new agarose gel electrophoresis method that allows the separation of LP(a) by Hellen REP system and the determination of LP(a)-C by enzymatic staining of cholesterol,The results of electrophoresis method were compared with the ones of INA and ITA. The specimens of 135 health men were assayed by electrophoresis for the reference range.Results The inter and intra CV of electrophoresis method at low, middle and high LP(a) concentration specimens were 4.7%～5.3% and 5.8%～6.4%. The linearity was 0.058～1.55 mmol/L. Interference with bilirubin (
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Lipoprotein(a) [Lp(a)] is an independent risk factor for cardiovascular disease that is a major cause of death in dialysis patients. It has been described to be increased in chronic renal failure patients on conservative treatment or dialysis. It has also been suggested that high concentration of Lp(a) correlates to malnutrition of hemodialysis patients, but this has unproven. The aim of our study was the evaluation of factors that affect changes of Lp(a) concentration through follow up in hemodialysis patients. We assessed the serum concentrations of lipoprotein(a), serum albumin, nPCR, various biochemical parameters and Kt/V as adequacy of dialysis in 25 hemodialysis patients over a 48-months period. The mean serum concentrations of Lp(a) were 40.0+/-21.3mg/dL at basal level, 39.2+/-16.6mg/dL after 48 months, respectively. Significant correlation was found between basal and follow up Lp(a) levels(r=0.76, p=0.0001). Moreover, a significant inverse correlation was observed between changes of serum Lp(a) level and changes of serum albumin level(r=-0.507, p=0.027). However no significant correlation was found between changes of serum Lp(a) level and changes of lipid profiles, nPCR, URR and Kt/V. Our data suggests the possibility of the influence of nutritional status(changes of serum albumin) on changes of serum Lp(a) level in hemodialysis patients. Further prospective studies are warranted to clarify the influence of nutritional status on the Lp(a) in hemodialysis patients.
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Humans , Cardiovascular Diseases , Cause of Death , Dialysis , Follow-Up Studies , Kidney Failure, Chronic , Lipoprotein(a) , Malnutrition , Nutritional Status , Renal Dialysis , Risk Factors , Serum AlbuminABSTRACT
OBJECTIVES: High serum Lp(a) concentration is associated with a high risk of coronary artery disease(CAD). This study was initiated to determine whether increased Lp(a) levels are associated with diabetic vascular complications in Korean patients with NIDDM. METHODS: A total of 183 NDDM patients were studied cross-sectionally for the presence of various vascular complications. Lp(a) levels were measured by 1-step sandwich ELISA method. RESULTS: The patients with overt proteinuria had higher Lp(a) levels than the patients with mormoalbuminuria or microalbuminuria(26.8mg/dl vs 13.8 mg/dl and 17.3mg/dl, p<0.05), The patients with proliferative retinopathy and/or those treated by photocoagulation had higher Lp(a) levels than those without retinopathy or those with background retinopathy(34.1mg/dl vs 13.3mg/dl and 16,9mg/dl, p<0.05), The Lp(a) levels were also higher in the patients with CAD than those without CAD(30.9mg/ dl vs 16.3mg/dl, p<0.05). Multiple logistic regression analysis revealed that high Lp(a) levels were independantly associated with CAD and severe diabetic retinopath3. CONCLUSION: High Lp(a) levels are associated with CAD and proliferative retinopathy in Korean patients with NIDDM.
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Humans , Coronary Artery Disease , Coronary Vessels , Diabetes Mellitus, Type 2 , Diabetic Angiopathies , Diabetic Nephropathies , Diabetic Retinopathy , Enzyme-Linked Immunosorbent Assay , Light Coagulation , Lipoprotein(a) , Logistic Models , ProteinuriaABSTRACT
OBJECTIVES: Arteriovenous fistula (AVF) is Achilles hill of patients receiving maintenance hemodialysis, but thrombosis of AVF is a frequently encountered problem in maintenance hemodialysis patients. AVF thrombosis or occlusion is known to be associated with old age, underlying diabetes mellitus, increased fibrinogen and factor VIII, short AVF maturation time, low dialyzer blood flow, etc. Recently, several reports suggested that high titer of IgG anticardiolipin antibody (IgG-ACA) is associated with single or repeated clotting of AVF and elevated Lp(a) level is associated with vascular access occlusion in patients under maintenance hemodialysis. This study is to investigate the relationship between AVF thrombosis and the presence of elevated titiers of LP(a) and IgG-ACA. METHODS: This study included 20 patients with end stage renal disease under hemodialysis via AVF. Ten subjects have had one or more episodes of AVF obstruction (group A). Another 10 subjects without episodes of AVF obstruction (group B) were selected matching with age, sex, underlying disease, duration of hemodialysis, blood glucose level and lipid profile of subjects in group A. The IgG, IgM anticardiolipin antibody titers with indirect ELISA method and LP(a) level with turbidimetric assay were measured and analysed. RESULTS: Four subjects in group A showed positive IgG-ACA titer what of all subjects in group B were negative titer (p=0.03). Only one subject in group A and two subjects in group B showed positive IgM-ACA titer (p>0.05). The median value of Lp(a) was 32.75 (mg/dl), 43.1 (mg/dl) in group A and group B respectively and was not significantly different each other (p>0.05). CONCLUSIONS: In end stage renal patients receiving hemodialysis, positive IgG-ACA titier seems to be an independent risk factor of AVF thrombosis.
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Humans , Antibodies, Anticardiolipin , Arteriovenous Fistula , Blood Glucose , Diabetes Mellitus , Enzyme-Linked Immunosorbent Assay , Factor VIII , Fibrinogen , Immunoglobulin G , Immunoglobulin M , Kidney Failure, Chronic , Lipoprotein(a) , Renal Dialysis , Risk Factors , ThrombosisABSTRACT
PURPOSE--To evaluate the effects of pravastatin on lipoproteins, Lp (a), apo B and apo A-I and its tolerability in primary hypercholesterolemic patients in our outpatient lipid clinic. METHODS--Twenty-two primary hypercholesterolemic patients were evaluated. They had all been treated previously with other hypocholesterolemic drugs, including the statins, forming a specific and homogeneous group with hypercholesterolemia and definite coronary risk. After 7 weeks with American Heart Association phase I diet and placebo drug, pravastatin was administered during 12 weeks. All patients received an initial daily dose of 10 mg for six weeks. After this period, this dose was increased to 20 mg. The levels of cholesterol, triglycerides, high-density lipoprotein, lipoprotein (a) and apolipoproteins A-1 and B were determined. RESULTS--No changes occurred with diet and placebo, but pravastatin at a daily dose of 10 mg, reduced significantly cholesterol level (7.22 per cent) LDL-cholesterol (13.08 per cent) and increased HDL-cholesterol (7.8 per cent). The results were better with 20 mg, achieving a reduction of (28.21 per cent) in cholesterol, (36.88 per cent) in LDL-cholesterol, (17.06 per cent) in apo B level and an increase of (10.06 per cent) in HDL-cholesterol. The smaller effect observed with the more commonly used dosage (10 mg/day) was most probably due to the characteristics of the sample with already established hypercholesterolemia, being thus dependent of higher concentrations of medications, as observed in previous treatments in our outpatient clinic. Side affects with this drug were rare. No biochemical changes were observed that would interrupt the continuation of therapy. CONCLUSION--Pravastatin was well tolerated and promoted favorable changes in the total cholesterol, LDL, apo B and cholesterol/HDL and LDL/HDL ratios of primary hypercholesterolemic patients
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Humans , Male , Female , Adult , Middle Aged , Pravastatin/pharmacology , Hypercholesterolemia/drug therapy , Lipoproteins , Pravastatin/administration & dosage , Cholesterol, HDL/drug effects , Cholesterol, LDL/drug effects , Apolipoprotein A-I , Apolipoproteins B , Lipoprotein(a)ABSTRACT
BACKGROUND: Lipoprotein(a)(Lp(a))is known as an independent risk factor of the coronary artery disease(CAD). However, it is not clear whether the level of the Lp(a) is elevated in the presence of atherosclerotic peripheral vascular disease(PVD) of lower extremities. MATERIALS AND METHODS: Considering high prevalence of the coronary artery disease in PVD, the association between the serum level of Lp(a) and the presence of PVD was investigated by comparing Lp(a) level in PVD patients with CAD(PVD+CAD group, N=15), PVD patients without CAD(PVD-CAD group, N=12), and control group who had normal coronary angiograms and no clinical evidence of PVD(Control group, N=22). In all PVD patients coronary angiograms were performed simultaneously with peripheral angiograms. Clinical characteristics, lipid profiles and the level of lipoprotein(a) were compared between two PVD group. The serum level of Lp(a) was measured with ELISA technique. RESULTS: Serum levels of lipoprotein(a) in patients with PVD as a whole(20.4+/-18.7mg/dl, mean standard deviation) were not significantly higher than those in control group(14.9+/-10.5mg/dl). In patients with PVD and CAD, the levels were significantly higher(27.0+/-20.2mg/dl) than those in patients with PVD but without CAD(12.2+/-13.3mg/dl). There was no significant difference between two groups with PVD in age, sex, association of hypertension, smoking, and other lipid profiles. CONCLUSIONS: Lipoprotein(a) level might not be related to the presence of PVD, but rather associated with CAD.
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Humans , Coronary Artery Disease , Coronary Vessels , Enzyme-Linked Immunosorbent Assay , Hypertension , Lipoprotein(a) , Lower Extremity , Peripheral Vascular Diseases , Prevalence , Risk Factors , Smoke , SmokingABSTRACT
AIM To study the effects of poly- N -acetylglucosamine on the metabolism of low density lipoprotein and lipoprotein (a). METHODS Poly- N -acetylglucosamine was injected into the body of hedgehogs viathe armpit vein 2 minutes before the 125 I low density lipoprotein ( 125 I-LDL), 125 I lipoprotein(a) 〔 125 I-Lp(a)〕, 125 I desialylated low density lipoprotein ( 125 I-ds-LDL) or 125 I desialylated lipoprotein(a) 〔 125 I-ds-Lp(a)〕 were injected separatively . The animals were put to death in one hour. The radioactivity in the blood, liver, kidney, spleen, gall and adrenal were measured. RESULTS Absorption of ds-LDL and ds-Lp(a) increased in the liver. Later ds-LDL was reutilized and released into blood, but the majority of ds-Lp(a) was excreted out of the body from liver. It was not eliminated that ds-LDL was metabolized via the LDL receptor for the uptake of ds-LDL also increased in the kidney and the adrenal. It is possible that ds-Lp(a) and the part of ds-LDL may be catabolized via the desialylated lipoprotein-related receptor. Poly- N -acetylglucosamine could increase the absorption of LDL in the liver and the adrenal, meanwhile the concentration of LDL decreased in the blood and the absorption of LDL decreased in the spleen. CONCLUSION Poly- N -acetylglucosamine has the effects of lowering lipids through activating LDL receptor.