Open AccessElevated lipoprotein(a) and familial hypercholesterolemia in the coronary care unit: Between Scylla and Charybdis
Author(s) -
Ellis Katrina L.,
Pang Jing,
Chieng David,
Bell Damon A.,
Burnett John R.,
Schultz Carl J.,
Hillis Graham S.,
Watts Gerald F.
Publication year - 2018
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22880
Subject(s) - medicine , familial hypercholesterolemia , coronary artery disease , coronary care unit , lipoprotein(a) , gastroenterology , logistic regression , acute coronary syndrome , lipoprotein , cardiology , endocrinology , cholesterol , myocardial infarction
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.