Lipoprotein (a), the Metabolic Syndrome and Vascular Risk in Angiographied Coronary Patients.

Abstract

Lipoprotein (a) [Lp(a)] especially in young individuals, is an important cardiovascular risk factor. However, data on the vascular risk conferred by Lp(a) in patients with the metabolic syndrome (MetS) are not available. Lp(a) was measured in a cohort of 593 consecutive patients undergoing coronary angiography for the evaluation of stable coronary artery disease. MetS was diagnosed according to International Diabetes Federation criteria. Vascular events were recorded over 10 years. Median Lp(a) was significantly lower in patients with the MetS (n = 307) than in subjects who did not have the MetS (12 [interquartile range, 0-35] mg/dl vs 17 [0-57] mg/dl; P = .004). Prospectively, 34% of our patients suffered vascular events. Lp(a) proved to be a strong and independent predictor of vascular events in subjects without the MetS (standardized adjusted hazard ratio [HR], 1.20 [1.05-1.38]; P = .006) but not in patients who had the MetS (HR, 0.96 [0.77-1.20]; P = .713). An interaction term MetS × Lp(a) was significant (P = .029), indicating that Lp(a) was a significantly stronger predictor of vascular events in subjects without the MetS than in patients with the MetS. Lp(a) in patients with the MetS is low and is not associated with the incidence of vascular events. The power of Lp(a) as a predictor of cardiovascular events is significantly modulated by the presence of the MetS.