Lipoprotein[a] and SYNTAX score association with severity of coronary artery atherosclerosis in North India

ABSTRACT

This cross-sectional study investigated the association of lipoprotein[a] [Lp[a]] levels as an atherosclerosis predictor and their relationship to the severity of coronary artery disease [CAD]. 360 consecutive patients at Sanjay Gandhi Postgraduate Institute of Medical Sciences and King George's Medical University hospitals, Lucknow, North India, with chest pains, CAD symptoms and on lipid-lowering therapy were enrolled between June 2009 and October 2011. Before coronary artery angiography [CAG], a fasting blood sample was assessed for lipid and Lp[a] levels. The synergy between percutaneous coronary intervention with taxus and cardiac surgery [SYNTAX] score was calculated according to the CAG results. Patients were divided into 3 groups based on CAD severity and SYNTAX scores. Angiography revealed CAD in 270 patients. Lp[a] levels were higher in CAD compared to non-CAD patients [48.7 +/- 23.8 mg/dl versus 18.9 +/- 11.1 mg/dl [P <0.0001]]. The levels of Lp[a] were lower in single than in double and triple vessels [39.3 +/- 18.4 mg/dl versus 58.0 +/- 23.0 mg/dl, and 69.2 +/- 24.1 mg/dl, [P <0.05]]. Lp[a] levels were significantly higher in severe CAD with SYNTAX score >30 [88.0 +/- 24.0 mg/dl]. Lp[a] levels correlated significantly with SYNTAX scores [r = 0.70, P <0.0001]. In this study, Lp[a] levels were positively associated with a patient's SYNTAX score in diseased vessels. Furthermore, an elevated Lp[a] level was a causal, independent risk factor of CAD. Lowering Lp[a] levels would reduce CAD in primary and secondary prevention settings. There is an urgent need to define more precisely which patients to treat and which to target for earlier interventions: