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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Lipoprotein(a)
Homocysteine
Lipoproteins
Atherosclerosis
Peripheral Vascular Diseases
Odds Ratio
Confidence Intervals
Antithrombin Proteins
Antiphospholipid Antibodies
Protein S
Protein C
Lower Extremity
Multivariate Analysis
Ischemia
Logistic Models

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Lipoprotein (a), homocysteine, and hypercoagulable states in young men with premature peripheral atherosclerosis : A prospective, controlled analysis. / Valentine, R. J.; Kaplan, H. S.; Green, Ralph; Jacobsen, D. W.; Myers, S. I.; Clagett, G. P.; Taylor, L. M.; Deiparine, M. K.; Brantigan, C. O.

In: Journal of Vascular Surgery, Vol. 23, No. 1, 1996, p. 53-63.

Research output: Contribution to journalArticle

Valentine, R. J. ; Kaplan, H. S. ; Green, Ralph ; Jacobsen, D. W. ; Myers, S. I. ; Clagett, G. P. ; Taylor, L. M. ; Deiparine, M. K. ; Brantigan, C. O. / Lipoprotein (a), homocysteine, and hypercoagulable states in young men with premature peripheral atherosclerosis : A prospective, controlled analysis. In: Journal of Vascular Surgery. 1996 ; Vol. 23, No. 1. pp. 53-63.
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title = "Lipoprotein (a), homocysteine, and hypercoagulable states in young men with premature peripheral atherosclerosis: A prospective, controlled analysis",
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.",
author = "Valentine, {R. J.} and Kaplan, {H. S.} and Ralph Green and Jacobsen, {D. W.} and Myers, {S. I.} and Clagett, {G. P.} and Taylor, {L. M.} and Deiparine, {M. K.} and Brantigan, {C. O.}",
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TY - JOUR

T1 - Lipoprotein (a), homocysteine, and hypercoagulable states in young men with premature peripheral atherosclerosis

T2 - A prospective, controlled analysis

AU - Valentine, R. J.

AU - Kaplan, H. S.

AU - Green, Ralph

AU - Jacobsen, D. W.

AU - Myers, S. I.

AU - Clagett, G. P.

AU - Taylor, L. M.

AU - Deiparine, M. K.

AU - Brantigan, C. O.

PY - 1996

Y1 - 1996

N2 - 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.

AB - 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.

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