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Ryu, Hong, Kwon, Kim, Chung, Park, Kim, Cho, Yoon, Yoon, Cho, and Kim: Age-related Contribution of Lp (a) with Coronary Artery Calcification in Patients with Acute Coronary Syndrome: a Potential Role of Metabolic Disorder in Calcified Plaque
Original Article
Yonsei Medical Journal

Yonsei Medical Journal 2003; 44(3): 445-453.

Published online: 30 March 2009

DOI: https://doi.org/10.3349/ymj.2003.44.3.445

Age-related Contribution of Lp (a) with Coronary Artery Calcification in Patients with Acute Coronary Syndrome: a Potential Role of Metabolic Disorder in Calcified Plaque

Sung Kee Ryu2, Bum Kee Hong1, Hyuck Moon Kwon1, Dong Soo Kim1, Wook Jin Chung1, Byoung Eun Park1, Dong Yeon Kim1, Yun Hyeong Cho1, Se Jung Yoon1, Young Won Yoon1, Seung Yun Cho1, Hyun Seung Kim1

1Yonsei Cardiovascular Center and Cardiovascular Research Institute, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

2Department of Internal Medicine, Eulji University College of Medicine, Seoul, Korea.

Reprint address: requests to Dr. Hyuck Moon Kwon, Department of Internal Medicine, Yonsei University College of Medicine, 146-92, Dogok-dong, Kangnam-gu, Seoul 135-270, Korea. Tel: 82-2-3497-3330, Fax: 82-2-573-0112, kwonhm@yumc.yonsei.ac.kr

Received 11 June 2002       Accepted 14 January 2003

Copyright © 2003 The Yonsei University College of Medicine

Abstract

Lp (a) and coronary artery calcification (CAC) have recently been reported as predictors of plaque instability, but this is surrounded by much controversy. We investigated the influence of Lp (a) and CAC compared other acute coronary syndrome (ACS) risk factors. 698 patients diagnosed with at least minimal coronary artery obstructive disease from a coronary angiography were randomly selected using SPSS.
Lp (a), other lipid profiles and past histories were checked, and CAC semi quantitatively graded on stored fluoroscopic images. The prevalence of CAC was significantly higher in the ACS than the non-ACS group (38.0% vs. 29.9%, p=0.026). The serum level of Lp (a) (26.89 ± 30.64 vs. 20.85 ± 21.63, p < 0.01) and prevalence of positive Lp (a) (> 35 mg/dl) was higher in the ACS group (24% vs. 15.7%, p < 0.01). The risk of ACS was higher in the patients with both CAC and elevated an Lp (a) than in those with only one (OR: 2.16, p=0.009, 95% CI; 1.213 - 3.843 vs. OR: 1.79, p < 0.001, 95% CI; 1.300 - 2.456). The risk of ACS was increased 1.451 times (p=0.040, 95% CI; 1.071- 2.071) in patients with CAC and 1.648 times (p=0.014, 95% CI; 1.107- 2.455) in patients with a Lp (a) > 35 mg/dl. In the younger patients (< 60 years), the Lp (a), but not the CAC, was an independent risk factor for ACS (OR=2.248, p=0.005, 95% CI; 1.281-3.943). In the older patients (> 60 years), CAC, but not the Lp (a), was an independent risk factor (OR=1.775, p=0.021, 95% CI; 1.090 - 2.890). Both the Lp (a) and CAC were risk factors for ACS, and they had a synergistic effect on its development. In the younger Lp (a), and the older CAC, was the more potent risk factor for ACS, respectively.

Keywords: Acute coronary syndrome, Lp (a), coronary artery calcification

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