CLINICAL STUDIES
Association between apolipoprotein(a) phenotypes and coronary heart disease at a young age
Carmine Gazzaruso, MD*,
Adriana Garzaniti, MD*,
Paola Buscaglia, MD*,
Graziella Bonetti, MD*,
Colomba Falcone, MD ,
Pietro Fratino, MD ,
Giorgio Finardi, MD* and
Diego Geroldi, MD, ScD*
* Department of Internal Medicine and Medical Therapeutics, Section of Internal Medicine, Vascular and Metabolic Diseases, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
Division of Cardiology, IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
Polo Universitario Convenzionato "Città di Pavia," Section of Internal Medicine, University of Pavia, Pavia, Italy
Manuscript received May 4, 1998;
revised manuscript received August 4, 1998,
accepted September 4, 1998.
Address for correspondence: Carmine Gazzaruso, MD, Clinica Medica 1, Policlinico San Matteo, Piazzale Golgi, 2, 27100 Pavia, Italy
Objectives. The purpose of this study was to investigate lipoprotein(a) [Lp(a)] levels and apolipoprotein(a) [apo(a)] phenotypes in relation to age of onset of coronary heart disease (CHD).
Background. Although Lp(a) levels have been extensively analyzed in relation to age of CHD, apo(a) phenotypes have not.
Methods. Three hundred and thirty-five consecutive CHD patients were enrolled and grouped according to their age of CHD onset (<45 years; 45 to 54 years;  55 years).
Results. In each patient group Lp(a) levels were higher than in an age-matched control group, but among the patient groups no differences in Lp(a) levels were observed. Apolipoprotein(a) phenotype distributions showed significant differences between patients and age-matched control subjects. Among the patient groups the difference in percentage of subjects with two apo(a) isoforms of low molecular weight (MW) was highly significant (p < 0.001). Multivariate analysis showed that apo(a) phenotypes were the best predictors of early CHD (p < 0.000001). The age-specific odds ratios (ORs) of the presence of at least one apo(a) isoform of low MW for CHD declined with age; in particular apo(a) phenotypes had their highest predictive value in younger persons (OR: 14.62). The OR for the presence of two isoforms of low MW/presence of only isoforms of high MW was 40.88 in the younger age group, 27.17 in age group of 45 to 54 years and 15.83 in the older age group.
Conclusions. The present article reports the first evidence of a strong independent association of apo(a) phenotypes with the age of onset of CHD. Thus, if our data are confirmed by larger studies, apo(a) phenotypes might be used together with Lp(a) levels as powerful genetic markers in assessing the actual risk of developing CHD at a young age.
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Abbreviations and Acronyms
| | apo(a) | = apolipoprotein(a) | | BMI | = body mass index | | CHD | = coronary heart disease | | HDL | = high density lipoprotein | | LDL | = low density lipoprotein | | Lp(a) | = lipoprotein(a) | | MW | = molecular weight | | OR | = odds ratio |
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