Arch Hellen Med, 23(5), September-October 2006, 514-520
The relationship of early atherosclerotic vascular changes with serum lipoprotein(a)
H. NASRI,1 A. BARADARAN2
OBJECTIVE Study of the effect of serum plasma Lp(a) levels on early structural atherosclerotic vascular changes in a group of CRF patients not yet on dialysis and end-stage renal disease patients under regular hemodialysis (HD).
METHOD This was a cross-sectional study. 29 normal subjects (group one, F=17, M=12), 33 chronic renal failure (CRF) patients not yet on dialysis (group two, F=19, M=14) and 43 HD patients with end-stage renal disease (group three, F=19, M=24). For all patients serum Lp(a) was measured. Carotid intima-media thickness (IMT) was measured and carotid-femoral artery examined for plaque occurrence (plaque score) by B-mode ultrasonography was determined.
RESULTS The mean±SD of serum Lp(a) in group one was 42.0±20.0 mg/dL, in the CRF group 57.0±23.0 mg/dL and in the HD group 55.0±16.0 mg/dL. The IMT of group one was 0.84±0.20 mm and the CRF group and HD group 1.30±0.40 mm and 1.10±0.30 mm, respectively. Ninety-three percent of persons of group one had zero plaque score while 39.4% of patients of group two (CRF) and 51.2% of patients in group three (HD) had zero plaque score while 6.8% of subjects in group one, 24.3% in group two and 25.6% of patients in group three had plaque scores of between 1 and 2. For plaque scores of 3 and 4, group one had none, group two had 36.4% and group three had 23.3%. Significant differences were found in IMT group one between group two (P<0.001) and group three (P=0.008), and also between group two and group three (P=0.023). Significant differences in Lp(a) between group one and group two (P=0.016) and group three (P=0.021) were demonstrated. No significant difference in Lp(a) between group two and group three (P>0.05) was found. Significant differences in plaque score between group one and group two (P<0.001) and group three (P=0.020) were found, but not between group two and group three (P>0.05). Positive correlations were found of serum Lp(a) with IMT and plaque score in HD patients.
CONCULSIONS This study showed a positive relationship of Lp(a) with IMT and arterial plaques in HD patients. Lp(a), as a non-traditional factor in the progression of atherosclerosis, could play an important role in the acceleration of rapid progressive atherosclerosis observed in HD patients, which needs further attention.
Key words: Chronic renal failure, Hemodialysis, Intima-media thickness, Lipoprotein(a), Plaque score.