CLINICAL RESEARCH: CORONARY ARTERY DISEASE
Relation Between Lipoprotein(a) and Fibrinogen and Serial Intravascular Ultrasound Plaque Progression in Left Main Coronary Arteries
Marc Hartmann, MD*,
Clemens von Birgelen, MD, PhD*,*,
Gary S. Mintz, MD ,
Martin G. Stoel, MD*,
Holger Eggebrecht, MD ,
Heinrich Wieneke, MD,
Martin Fahy, MSc,
Till Neumann, MD,
Job van der Palen, MSc*,
Hans W. Louwerenburg, MD*,
Patrick M.J. Verhorst, MD, PhD* and
Raimund Erbel, MD
* Department of Cardiology, Medisch Spectrum Twente, Enschede, the Netherlands
Department of Cardiology, Essen University, Essen, Germany
Cardiovascular Research Foundation, New York, New York
Manuscript received February 10, 2006;
revised manuscript received March 21, 2006,
accepted March 28, 2006.
* Reprint requests and correspondence: Dr. Clemens von Birgelen, Medisch Spectrum Twente, Thoraxcentrum Twente, Cardiology Department, Haaksbergerstraat 55, 7513ER Enschede, the Netherlands. (Email: von.birgelen{at}12move.nl).
OBJECTIVES: Patients with elevated lipoprotein(a) [Lp(a)] and fibrinogen levels have an increased risk of coronary heart disease and adverse cardiovascular events. There is evidence that coronary plaque progression is linked to a higher risk for future cardiovascular events.
BACKGROUND: There are no data demonstrating a relation between Lp(a), fibrinogen, and directly measured coronary plaque progression over time.
METHODS: We performed a retrospective analysis of serial intravascular ultrasound (IVUS) studies of 60 left main stems (18 ± 9 months apart) to evaluate plaque progression in relation to Lp(a) and fibrinogen levels and association with adverse cardiovascular events.
RESULTS: There was a positive correlation between Lp(a) (r = 0.58; p < 0.0001), fibrinogen (r = 0.48; p < 0.0001), and changes in plaque-plus-media area. Patients with plaque progression (n = 41) had higher Lp(a) (30 ± 26 mg/dl vs. 14 ± 9 mg/dl; p < 0.0012) and fibrinogen (295 ± 88 mg/dl vs. 240 ± 72 mg/dl; p = 0.019) levels than patients with plaque regression (n = 19). Multivariate linear regression analysis showed Log Lp(a) (regression coefficient = 9.45; p = 0.0008) but not fibrinogen to be independently associated with plaque progression. A total of 19 patients suffered from adverse cardiovascular events; they had higher Lp(a) (44 ± 30 mg/dl vs. 16 ± 12 mg/dl; p < 0.0001) and fibrinogen (342 ± 73 mg/dl vs. 248 ± 76 mg/dl; p < 0.0001) levels. Multivariate logistic regression analysis showed Log Lp(a) (odds ratio 10.20, 95% confidence interval 2.36 to 44.13; p = 0.0019) and fibrinogen (odds ratio 1.01, 95% confidence interval 1.00 to 1.03; p = 0.018) were independently associated with adverse cardiovascular events.
CONCLUSIONS: Serial IVUS showed a positive correlation between Lp(a) and fibrinogen levels and plaque progression. Lp(a), but not fibrinogen, remains independently associated with plaque progression. In addition, the present data suggest a considerable incremental value of Lp(a) in predicting cardiovascular risk.
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Abbreviations and Acronyms
| | CI = confidence interval | | CSA = cross-sectional area | | EEM = external elastic membrane | | HDL = high-density lipoprotein | | IVUS = intravascular ultrasound | | LDL = low-density lipoprotein | | Lp(a) = lipoprotein(a) | | PCI = percutaneous coronary intervention | | P&M = plaque plus media |
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