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zahedi avval F, Moammeri Salahshooh M, sadabadi F. Lipoprotein(a) and its Clinical Importance. MEDICAL LABORATORY JOURNAL 2020. [DOI: 10.29252/mlj.14.2.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Maranhão RC, Carvalho PO, Strunz CC, Pileggi F. Lipoprotein (a): structure, pathophysiology and clinical implications. Arq Bras Cardiol 2015; 103:76-84. [PMID: 25120086 PMCID: PMC4126764 DOI: 10.5935/abc.20140101] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 10/01/2013] [Indexed: 11/20/2022] Open
Abstract
The chemical structure of lipoprotein (a) is similar to that of LDL, from which it
differs due to the presence of apolipoprotein (a) bound to apo B100 via one disulfide
bridge. Lipoprotein (a) is synthesized in the liver and its plasma concentration,
which can be determined by use of monoclonal antibody-based methods, ranges from <
1 mg to > 1,000 mg/dL. Lipoprotein (a) levels over 20-30 mg/dL are associated with
a two-fold risk of developing coronary artery disease. Usually, black subjects have
higher lipoprotein (a) levels that, differently from Caucasians and Orientals, are
not related to coronary artery disease. However, the risk of black subjects must be
considered. Sex and age have little influence on lipoprotein (a) levels. Lipoprotein
(a) homology with plasminogen might lead to interference with the fibrinolytic
cascade, accounting for an atherogenic mechanism of that lipoprotein. Nevertheless,
direct deposition of lipoprotein (a) on arterial wall is also a possible mechanism,
lipoprotein (a) being more prone to oxidation than LDL. Most prospective studies have
confirmed lipoprotein (a) as a predisposing factor to atherosclerosis. Statin
treatment does not lower lipoprotein (a) levels, differently from niacin and
ezetimibe, which tend to reduce lipoprotein (a), although confirmation of ezetimibe
effects is pending. The reduction in lipoprotein (a) concentrations has not been
demonstrated to reduce the risk for coronary artery disease. Whenever higher
lipoprotein (a) concentrations are found, and in the absence of more effective and
well-tolerated drugs, a more strict and vigorous control of the other coronary artery
disease risk factors should be sought.
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Affiliation(s)
- Raul Cavalcante Maranhão
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Priscila Oliveira Carvalho
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Celia Cassaro Strunz
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Fulvio Pileggi
- Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Noshad H, Ardalan MR, Mortazavi M, Tayebi H, Safa J, Nezami N. Kidney transplantation candidates and cardiovascular risk factors. Transplant Proc 2007; 39:871-4. [PMID: 17524836 DOI: 10.1016/j.transproceed.2007.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to determine the prevalence of cardiovascular disease and risk factors among chronic renal failure (CRF) patients on the transplantation waiting list. METHODS Fifty CRF patients on chronic hemodialysis who underwent evaluation for transplantation were compared with 60 hypertensive patients matched for age. We used Framingham scoring to calculate the absolute risk; relative risk was calculated based on the low-risk Framingham cohort. RESULTS According to traditional risk factors, a significant difference was observed in systolic blood pressure and total cholesterol (greater in the hypertensive group), and in the prevalence of the male gender, smoking, and diabetes, which were greater in the CRF group. The latter had a greater degree of left ventricular hypertrophy, lower diastolic blood pressure, and a lower prevalence of familial history of cardiovascular disease and obesity. Patients with CRF had a greater relative risk compared with the Framingham control population, but it did not differ from that observed in the group of hypertensive individuals. CONCLUSION The prevalence of cardiovascular disease and traditional risk factors is high among renal transplantation candidates. The Framingham equations do not adequately quantify the real cardiovascular risk; other risk factors specific for that population probably contribute to their greater cardiovascular risk.
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Affiliation(s)
- H Noshad
- Nephrology Division, Department of Internal Medicine, Sina Hospital, Tabriz University of Medical Sciences, Tabriz, East Azerbaijan, Iran.
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Abstract
Cardiovascular disease (CVD) is the major cause of morbidity and mortality in patients with renal failure. Patients with chronic kidney disease have significant CVD, and carry a high cardiovascular burden by the time they commence renal replacement therapy (RRT). The severity of CVD that has been observed in dialysis patients lead to a growing body of research examining the pathogenesis and progression of CVD during the progression of chronic kidney disease (CKD) to end-stage renal disease (ESRD) (ie, predialysis phase). Multiple factors are involved in the development of CVD in CKD. More importantly, critical and key factors seem to develop early in the course of CKD, and result in preventable worsening of CVD in this patient population. Anemia is common in patients with CKD, and has been shown to have an independent role in the genesis of left ventricular hypertrophy (LVH) and subsequent CVD. Unfortunately, it is underdiagnosed and undertreated in patients with CKD. Early intervention, and better correction of anemia, seems to gain a great momentum in the prevention and management of CVD in CKD. Hypertension is another risk factor that has been targeted by the National Kidney Foundation Task Force on CVD in chronic kidney disease. This article reviews the different factors involved in the pathogenesis of CVD in CKD and the evidence supporting early and aggressive intervention.
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Affiliation(s)
- Majd I Jaradat
- Department of Medicine, Indiana University School of Medicine and the Roudebush Veterans Affairs Medical Center, Indianapolis, IN 46202, USA
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Kovesdy CP, Astor BC, Longenecker JC, Coresh J. Association of kidney function with serum lipoprotein(a) level: the third National Health and Nutrition Examination Survey (1991-1994). Am J Kidney Dis 2002; 40:899-908. [PMID: 12407633 DOI: 10.1053/ajkd.2002.36319] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Elevated lipoprotein(a) (Lp[a]) levels have been observed in patients on dialysis therapy. However, few studies explored the relationship between kidney function and Lp(a) levels in patients with mild to moderate chronic kidney disease. METHODS We examined the association of estimated glomerular filtration rate (GFR) with Lp(a) level in 7,675 participants in the second phase of the Third National Health and Nutrition Examination Survey. RESULTS There was no association between Lp(a) level and estimated GFR in the overall sample (geometric mean, 10.4 mg/dL [95% confidence interval (CI), 9.2 to 11.8] in the group with a GFR of 90 to 149 mL/min/1.73 m2 versus 9.3 mg/dL [95% CI, 7.9 to 11.0] in the group with a GFR of 60 to 89 mL/min/1.73 m2 versus 12.1 mg/dL [95% CI, 9.0 to 15.9] in the group with a GFR of 15 to 59 mL/min/1.73 m2; P = 0.77 for linear trend) or non-Hispanic whites (geometric mean, 8.9 mg/dL [95% CI, 7.8 to 10.2] versus 8.5 mg/dL [95% CI, 7.1 to 10.2] versus 10.9 mg/dL [95% CI, 8.1 to 14.7]; P = 0.54 for linear trend). However, non-Hispanic blacks (geometric mean, 30.4 mg/dL [95% CI, 28.0 to 33.0] versus 35.2 mg/dL [95% CI, 31.4 to 39.4] versus 40.2 mg/dL [95% CI, 27.7 to 58.2]; P = 0.01 for linear trend) and Mexican Americans (geometric mean, 6.2 mg/dL [95% CI, 5.3 to 7.2] versus 7.4 mg/dL [95% CI, 6.4 to 8.5] versus 11.0 mg/dL [95% CI, 5.7 to 20.3]; P = 0.04 for linear trend) showed modestly, but significantly, greater Lp(a) levels with lower GFRs. In a weighed quantile regression model adjusted for age, sex, and race, a lower GFR was associated with greater 95th percentile serum Lp(a) values in the overall sample and non-Hispanic whites and with greater median Lp(a) levels in Mexican Americans. CONCLUSION In a cross-section of the US population, a low GFR is associated with only moderately greater Lp(a) levels, and this association may differ by race-ethnicity.
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Affiliation(s)
- Csaba P Kovesdy
- Division of Renal Medicine, Salem Veterans Affairs Medical Center, Salem, VA 24153, USA.
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Kimak E, Solski J. ApoA- and apoB-containing lipoproteins and Lp(a) concentration in non-dialyzed patients with chronic renal failure. Ren Fail 2002; 24:485-92. [PMID: 12212828 DOI: 10.1081/jdi-120006775] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND End-Stage renal disease is associated with accelerated atherosclerosis and a high incidence of cardiovascular disease. METHODS The serum levels of lipids and apolipoproteins and Lp(a) were determined in 51 patients with chronic renal failure (CRF) with various advancement, without interference of factors which might disturb Lp(a) metabolism and with proteinuria less than 0.5 g/24 h. The patients studied were divided into two groups: patients with moderate renal failure (CRF-M) and creatinine levels of 2-6mg/dL n = 27; and predialysis patients with end stage renal disease (ESRD) and creatinine levels higher than 8.5 mg/dL n=24. RESULTS In both studied groups serum concentrations of triglycerides (TG), total apoCIII, apoCIIInonB, apoB:CIII were statistically increased, (except total cholestrol (TC) and LDL-cholestrol (LDL-C), apoB, total apoE, apoEnonB, apoB:E), while the levels of HDL-cholestrol (HDL-C) and apoAl significantly decreased. Lipid and lipoprotein ratios as risk factors of atherosclerosis were similar in both groups. The TC/HDL-C ratio increased, while that of HDL-C/ apoAI and apoAI/apoCIII decreased. Serum Lp(a) concentrations were significantly increased in both studied groups. The medians and ranges of Lp(a) concentration were similar in both groups. Serum Lp(a) levels correlated with total cholesterol (r=0.295; p < 0.05), LDL-C (r = 0.312; p < 0.05) and apoB (r = 0.215; p < 0.05). In addition, no correlation was found between Lp(a) levels and albumin concentrations (r = 0.126; p = 0.421). CONCLUSION Our results may indicate that the reduced levels of apoA-containing lipoproteins and increased TG-rich apoB-containing lipoproteins and Lp(a) indicated a clear atherogenic pattern in early renal disease. Increased Lp(a) concentration may result in nonspecific synthesis or catabolism disturbances. Measurement and monitoring of lipoprotein family profiles offers a new means for selecting appropriate therapies targeted for normalizing dyslipidemia in non-dialyzed patients.
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Affiliation(s)
- Elibieta Kimak
- Department of Clinical Laboratory Diagnostics, Medical University of Lublin, Poland.
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Enríquez L, Matas P. [Lipoprotein (a): physiopathology and clinical and therapeutic considerations]. Med Clin (Barc) 2001; 116:746-9. [PMID: 11412698 DOI: 10.1016/s0025-7753(01)71972-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- L Enríquez
- Unidad de Endocrinología y Nutrición, Hospital San Pedro de Alcántara, Cáceres
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Kronenberg F, Kuen E, Ritz E, Junker R, König P, Kraatz G, Lhotta K, Mann JFE, Müller GA, Neyer U, Riegel W, Riegler P, Schwenger V, VON Eckardstein A. Lipoprotein(a) serum concentrations and apolipoprotein(a) phenotypes in mild and moderate renal failure. J Am Soc Nephrol 2000; 11:105-115. [PMID: 10616846 DOI: 10.1681/asn.v111105] [Citation(s) in RCA: 163] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
High lipoprotein(a) (Lp(a)) serum concentrations and the underlying apolipoprotein(a) (apo(a)) phenotypes are risk factors for cardiovascular disease in the general population as well as in patients with renal disease. Lp(a) concentrations are markedly elevated in patients with end-stage renal disease. However, nothing is known about the changes of Lp(a) depending on apo(a) size polymorphism in the earliest stages of renal impairment. In this study, GFR was measured by iohexol technique in 227 non-nephrotic patients with different degrees of renal impairment and was then correlated with Lp(a) serum concentrations stratified according to low (LMW) and high (HMW) molecular weight apo(a) phenotypes. Lp(a) increased significantly with decreasing GFR. Such an increase was dependent on apo(a) phenotype. Only renal patients with HMW apo(a) phenotypes expressed higher median Lp(a) concentrations, i.e., 6.2 mg/dl at GFR >90 ml/min per 1.73 m2, 14.2 at GFR 45 to 90 ml/min per 1.73 m2, and 18.0 mg/dl at GFR <45 ml/min per 1.73 m2. These values were markedly different when compared with apo(a) phenotype-matched control subjects who had a median level of 4.4 mg/dl (ANOVA, linear relationship, P < 0.001). In contrast, no significant differences were observed at different stages of renal function in patients with LMW apo(a) phenotypes when compared with phenotype-matched control subjects. The elevation of Lp(a) was independent of the type of primary renal disease and was not related to the concentration of C-reactive protein. Multiple linear regression analysis found that the apo(a) phenotype and GFR were significantly associated with Lp(a) levels. Non-nephrotic-range proteinuria modified the association between GFR and Lp(a) levels. In summary, an increase of Lp(a) concentrations, compared with apo(a) phenotype-matched control subjects, is seen in non-nephrotic patients with primary renal disease even in the earliest stage when GFR is not yet subnormal. This change is found only in subjects with HMW apo(a) phenotypes, however.
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Affiliation(s)
- Florian Kronenberg
- Institute of Medical Biology and Human Genetics, University of Innsbruck, Austria
| | - Erich Kuen
- Institute of Medical Biology and Human Genetics, University of Innsbruck, Austria
| | - Eberhard Ritz
- Department of Internal Medicine, Division of Nephrology, Ruperto-Carola-University, Heidelberg, Germany
| | - Ralf Junker
- Institute of Clinical Chemistry and Laboratory Medicine and Institute of Arteriosclerosis Research, University of Münster, Germany
| | - Paul König
- Innsbruck University Hospital, Department of Clinical Nephrology, Innsbruck, Austria
| | - Günter Kraatz
- Department of Internal Medicine A, Ernst-Moritz-Arndt-University, Greifswald, Germany
| | - Karl Lhotta
- Innsbruck University Hospital, Department of Clinical Nephrology, Innsbruck, Austria
| | | | - Gerhard A Müller
- Department of Nephrology and Rheumatology, Georg-August-University, Göttingen, Germany
| | - Ulrich Neyer
- Feldkirch Hospital, Department of Nephrology, Feldkirch, Austria
| | - Werner Riegel
- Medizinische Universitätskliniken des Saarlandes, Innere Medizin IV, Homburg/Saar, Germany
| | - Peter Riegler
- Bozen Hospital, Division of Nephrology and Hemodialysis, Bozen, Italy
| | - Vedat Schwenger
- Department of Internal Medicine, Division of Nephrology, Ruperto-Carola-University, Heidelberg, Germany
| | - Arnold VON Eckardstein
- Institute of Clinical Chemistry and Laboratory Medicine and Institute of Arteriosclerosis Research, University of Münster, Germany
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Sechi LA, Zingaro L, Catena C, Perin A, De Marchi S, Bartoli E. Lipoprotein(a) and apolipoprotein(a) isoforms and proteinuria in patients with moderate renal failure. Kidney Int 1999; 56:1049-57. [PMID: 10469373 DOI: 10.1046/j.1523-1755.1999.00621.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Atherosclerotic diseases are a major cause of death in patients with renal failure. Increased serum concentrations of lipoprotein(a) [Lp(a)] have been established as a genetically controlled risk factor for these diseases and have been demonstrated in patients with moderate renal failure, suggesting that this lipoprotein contributes to the increased cardiovascular risk seen in these patients. Variable alleles at the apolipoprotein(a) [apo(a)] gene locus are the main determinants of the serum Lp(a) level in the general population. The purpose of this study was to investigate apo(a) isoforms in patients with moderate renal failure and mild proteinuria (less than 1.0 g/day). METHODS In 250 consecutive subjects recruited at a hypertension clinic, we assessed the renal function by 24-hour creatinine clearance, proteinuria, and microalbuminuria, as well as the prevalence of atherosclerotic disease, and we also measured apo(a) isoforms, serum albumin, and Lp(a) concentrations. RESULTS Moderate impairment of renal function (creatinine clearance, 30 to 89 ml/min per 1.73 m2 of body surface area) was found in 97 patients. Lp(a) levels were significantly greater in patients with moderate renal failure (21.7+/-23.9 mg/dl) as compared with patients with normal renal function (15.6+/-16.4 mg/dl, P<0.001), and an inverse correlation was observed between log Lp(a) and creatinine clearance (r = -0.181, P <0.01). However, no difference was found in the frequency of low molecular weight apo(a) isoforms between patients with normal (25.5%) and impaired (27.8%) renal function. Only patients with the smallest size apo(a) isoforms exhibited significantly elevated levels of Lp(a), whereas the large-size isoforms had similar concentrations in patients with normal and impaired renal function. No significant relationship was found between serum Lp(a) and proteinuria. Clinical and laboratory evidence of one or more events attributed to atherosclerosis was found in 9.8% of patients with normal renal function and 25.8% of patients with moderate renal failure (P<0.001). CONCLUSIONS These results indicate that renal failure per se or other genes beside the apo(a) gene locus are responsible for the elevation of serum Lp(a) levels in patients with moderate impairment of renal function. The elevation of Lp(a) levels occurs independently of the level of proteinuria and may contribute to the risk for atherosclerotic disease in these patients.
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Affiliation(s)
- L A Sechi
- Department of Internal Medicine, University of Udine, Italy.
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Karádi I. Cemetery for lipoprotein (a): the kidney. Eur J Clin Invest 1998; 28:453-5. [PMID: 9693936 DOI: 10.1046/j.1365-2362.1998.00320.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- I Karádi
- Semmelweis Medical University, Kútvölgyi Clinical Center, Budapest, Hungary
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Kronenberg F. Homocysteine, lipoprotein(a) and fibrinogen: metabolic risk factors for cardiovascular complications of chronic renal disease. Curr Opin Nephrol Hypertens 1998; 7:271-8. [PMID: 9617557 DOI: 10.1097/00041552-199805000-00006] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
High plasma concentrations of homocysteine, lipoprotein(a) and fibrinogen are accompanied by an increased risk for cardiovascular complications in the general population. All three parameters are markedly elevated in patients with renal disease, a group with a high prevalence and incidence of cardiovascular complications. This review discusses these parameters in such patients in relation to the occurrence of atherosclerotic complications.
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Affiliation(s)
- F Kronenberg
- Institute of Medical Biology and Human Genetics, University of Innsbruck, Austria.
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