CORRELATIONS OF LOW MOLECULAR WEIGHT PHENOTYPE OF APOPROTEIN(A) AND SERUM LEVEL OF LIPOPROTEIN(A) WITH MULTIFOCAL ATHEROSCLEROSIS IN PATIENTS WITH CORONARY HEART DISEASE

Background. Atherosclerosis is a systemic disease. That is why the damage is not restricted by one vascular area in 18-50% of patients. High serum level of lipoprotein(a) [Lp(a)] is an independent risk factor for coronary, carotid and peripheral atherosclerosis. However the correlation of apoprotein(a) [apo(a)] polymorphism with the multifocal atherosclerosis in coronary heart disease (CHD) is not sufficiently studied.

Aim. To study the correlation of apo(a) phenotype with the multifocal atherosclerosis in CHD patients.

Material and Methods. 220 patients aged 32- 76 y.o. with the proven coronary and carotid atherosclerosis were split into two groups depending on the presence (n=22) or absence (n=198) of peripheral atherosclerosis. Evaluation of lipid profile, Lp(a) and determination of apo(a) isoforms by SDS electrophoresis in polyacrylamide gel and immunoblotting was performed in all patients.

Results. Both groups of patients were comparable by age, sex, classical cardiovascular risk factors, including frequency of hyperlipidemia and diabetes mellitus, lipid profile. The Lp(a) serum level ≥30 mg/dL and low molecular weight (LMW) apo(a) phenotype were found more often in patients with multifocal than coronary and carotid atherosclerosis: 55 and 45% (р=0.372); 73 and 44% (p<0.05), respectively. According to multiple regression analysis (including sex, age, smoking status, and Lp(a) serum level) only smoking status (β=0.203, p=0.0003) and a size of apo(a) isoforms (β=0.191, p=0.0133) correlated with the peripheral atherosclerosis in patients with CHD. LMW apo(a) phenotype was the most significant predictor of peripheral atherosclerosis (β=0.281, p=0.0089) regardless of the Lp(a) serum level in patients under 55 y.o. High Lp(a) serum level combined with LMW apo(a) phenotype associated with more significant coronary, carotid and peripheral atherosclerosis.

Conclusion. LMW apo(a) phenotype relates to the presence of multifocal atherosclerosis in CHD patients regardless of the Lp(a) serum level. Apo(a) phenotype can be a marker of generalized atherosclerosis especially among young adults. Next studies of correlations Lp(a) and apo(a) phenotype with lower limb arteries lesions are needed in various patients.

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