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. 2018 Mar;41(3):378-384.
doi: 10.1002/clc.22880. Epub 2018 Feb 26.

Elevated lipoprotein(a) and familial hypercholesterolemia in the coronary care unit: Between Scylla and Charybdis

Katrina L Ellis  1   2 , Jing Pang  1 , David Chieng  3 , Damon A Bell  1   3 , John R Burnett  1   4 , Carl J Schultz  1   3 , Graham S Hillis  1   3 , Gerald F Watts  1   3
Affiliations

Elevated lipoprotein(a) and familial hypercholesterolemia in the coronary care unit: Between Scylla and Charybdis

Katrina L Ellis et al. Clin Cardiol. 2018 Mar.

Abstract

Background: Elevated lipoprotein(a) (Lp[a]) and familial hypercholesterolemia (FH) are inherited lipid disorders. Their frequencies, coexistence, and associations with premature coronary artery disease (CAD) in patients admitted to the coronary care unit (CCU) remain to be defined.

Hypothesis: Elevated Lp(a) and FH are commonly encountered among CCU patients and independently associated with increased premature CAD risk.

Methods: Plasma Lp(a) concentrations were measured in consecutive patients admitted to the CCU with an acute coronary syndrome (ACS) or prior history of CAD for 6.5 months. Elevated Lp(a) was defined as concentrations ≥0.5 g/L. Patients with LDL-C ≥ 5 mmol/L exhibited phenotypic FH. Premature CAD was diagnosed in those age < 60 years, and the relationship between this and elevated Lp(a) and FH was determined by logistic regression.

Results: 316 patients were screened; 163 (51.6%) had premature CAD. Overall, elevated Lp(a) and FH were identified in 27.0% and 11.6% of patients, respectively. Both disorders were detected in 4.4% of individuals. Elevated Lp(a) (32.0% vs 22.2%; P = 0.019) and FH phenotype (15.5% vs 8.0%; P = 0.052) were more common with premature vs nonpremature CAD. Elevated Lp(a) alone conferred a 1.9-fold, FH alone a 3.2-fold, and the combination a 5.3-fold increased risk of premature CAD (P = 0.005).

Conclusions: Elevated Lp(a) and phenotypic FH were commonly encountered and more frequent with premature CAD. The combination of both disorders is especially associated with increased CAD risk. Patients admitted to the CCU with ACS or previously documented CAD should be routinely screened for elevated Lp(a) and FH.

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Conflict of interest statement

The authors declare no potential conflicts of interest.

Figures

Figure 1
Figure 1
The frequency of elevated Lp(a) and FH phenotype in patients with premature and nonpremature CAD. Abbreviations: CAD, coronary artery disease; FH, familial hypercholesterolemia; Lp(a), lipoprotein(a)
Figure 2
Figure 2
Association between elevated Lp(a) and FH phenotype with the risk of having a premature CAD event. Analyses adjusted for sex, T2DM, HTN, smoking status, Cr, and statin therapy at admission. Abbreviations: CAD, coronary artery disease; Cr, creatinine; FH, familial hypercholesterolemia; HTN, hypertension; Lp(a), lipoprotein(a); OR, odds ratio; SEM, standard error of the mean; T2DM, type 2 diabetes mellitus
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