Lipoprotein (a), homocysteine, and hypercoagulable states in young men with premature peripheral atherosclerosis: A prospective, controlled analysis

R. J. Valentine, H. S. Kaplan, Ralph Green, D. W. Jacobsen, S. I. Myers, G. P. Clagett, L. M. Taylor, M. K. Deiparine, C. O. Brantigan

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Abstract

Purpose: Elevated lipoprotein (a) (Lp[a]) lipoprotein, total homocysteine, and hypercoagulable states (HCS) have all been implicated as risk factors for premature-onset atherosclerosis. This study was performed to determine the prevalence of these abnormalities in young men with chronic lower extremity ischemia (peripheral vascular disease [PVD]) and to determine their relative strengths as risk factors for premature peripheral atherosclerosis. Methods: We analyzed 50 young white men (age 45 years or younger at onset of symptoms) and compared them with 45 age-matched white male control subjects. Results: Atherosclerotic risk factors were similar in both groups. The mean (± SEM) Lp(a) lipoprotein level was 36 ± 6 mg/dl among the study patients, compared with 14 ± 2 mg/dl among control subjects (p = 0.02, Mann-Whitney). Twenty (40%) study patients and seven (16%) control subjects had Lp(a) lipoprotein levels of 30 mg/dl or greater (atherosclerotic risk threshold) (p = 0.01, odds ratio = 3.62, confidence interval (CI) 1.4 to 9.5). Positive HCS panels (antiphospholipid antibodies or deficiencies in antithrombin III, protein C, or protein S) were nearly twice as prevalent in study patients (n = 15, 30%) as in controls (n = 8, 18%), but this difference did not achieve statistical significance. The mean total plasma homocysteine level among the study patients was 15.9 ± 0.9 μmol/L, which was not significantly different from the mean control value of 14.7 ± 0.7 μmol/L. Lp(a) lipoprotein was related to risk of premature PVD through a linear logistic relationship (p = 0.003, odds ratio per each 1 mg/dl Lp(a) change was 1.03, CI 1.0 to 1.1). Multivariate analysis with stepwise logistic regression selected two variables: Lp(a) lipoprotein ≥30 mg/dl (p = 0.01, odds ratio = 3.6, CI 1.3 to 9.9) and family history (p = 0.07, odds ratio = 2.2, CI 0.9 to 5.3). Tests of interaction demonstrated no effect between Lp(a) lipoprotein, HCS, and homocysteine. Conclusions: Lp(a) lipoprotein of 30 mg/dl or greater is an independent risk factor for premature peripheral atherosclerosis in men. None of the other examined variables exhibited a significant association with premature PVD.

Original languageEnglish (US)
Pages (from-to)53-63
Number of pages11
JournalJournal of Vascular Surgery
Volume23
Issue number1
DOIs
StatePublished - 1996
Externally publishedYes

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ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Valentine, R. J., Kaplan, H. S., Green, R., Jacobsen, D. W., Myers, S. I., Clagett, G. P., Taylor, L. M., Deiparine, M. K., & Brantigan, C. O. (1996). Lipoprotein (a), homocysteine, and hypercoagulable states in young men with premature peripheral atherosclerosis: A prospective, controlled analysis. Journal of Vascular Surgery, 23(1), 53-63. https://doi.org/10.1016/S0741-5214(05)80035-7