ASSOCIATION BETWEEN LIPOPROTEIN(A) AND PROGRESSION OF CORONARY-ARTERY DISEASE IN MIDDLE-AGED MEN

The association between lipoprotein(a) (Lp[a]) and progression of coronary artery disease (CAD) compared with other serum lipids was evaluated in 104 patients with angiographically proven coronary atherosclerosis. Patients were randomized to either an intervention or a control group. The 12-month intervention program consisted of a low fat diet and daily physical exercise. Patients in the control group received ''usual care'' by their private physician. Eighty-three patients (36 in the intervention and 47 in the control group) underwent repeat angiography after 1 year. Angiographically documented net regression was seen in 13 patients (8 in the intervention and 5 in the control group), no change was seen in 40 patients (21 in the intervention and 19 in the control group) and progression was noted in 30 patients (7 in the intervention and 23 in the control group). No correlation could be shown between Lp(a) and angiographically documented progression of the disease. In a multivariate analysis including metabolic variables, group assignment, age and smoking habits, only assignment to the intervention group, (p = 0.0075) and a decrease in total cholesterol (p = 0.0167) were independently associated with the course of the disease. Patients with or without previous myocardial infarction (70 vs 34) did not differ in Lp(a) levels (median 9.15 vs 14.25 mg/dl). Patients with Lp(a) >25 mg/dl were younger than patients with Lp(a) less than or equal to 25 mg/dl (52 vs 55 years; p <0.03), indicating a connection between Lp(a) and the development of premature CAD. It is concluded that Lp(a) levels in middle-aged Caucasian men with CAD but without prominent primary or secondary hyperlipidemia due to other than alimentary causes have no association with progression of the disease, even though high Lp(a) levels might have contributed to the early development of the disease.