Correlation Between Lipoprotein (a) And Valvular Heart Disease In Patients With Coronary Heart Disease

BackgroundLipoprotein(a)(Lp(a))is similar to low-density lipoproteins(LDL)and contains apoB100.The unique feature of Lp(a)is that the glycoprotein apolipoprotein(a)encoded by LPA gene can play a pathophysiological role by binding with apoB100 through disulfide bond.Epidemiological and genetic studies have confirmed that the risk of atherothrombotic thrombosis is related to an increased level of Lp(a)in the plasma,and that calcified aortic valve disease is related to Lp(a).Lp(a)can interact with autotoxin(ATX)in blood to promote the calcification of aortic valve.Previous studies have found that the increase of Lp(a)is related to the increased risk of aortic stenosis(as).In patients with peripheral vascular disease(PAD),Lp(a)level is not related to the occurrence of valvular disease(VHD),but in subgroup analysis,Lp(a)level is related to the risk of as and MS.Interestingly,in the study of coronary heart disease(CHD)and non-CHD elderly patients(?70 years old),the level of Lp(a)was only related to the clinical symptoms of CHD,but not to AS.Therefore,there are differences in the correlation between Lp(a)and VHD in different populations and diseases.Previous studies have found that Lp(a)is positively correlated with the occurrence of left main coronary artery disease in patients with acute coronary syndrome,and Lp(a)is an independent risk factor of CHD,and high Lp(a)is the residual risk of CHD.Whether the increased serum Lp(a)level in CHD patients is correlated with VHD is still an issue and at present,there is no study to explore it.ObjectiveThis paper aims to explore the risk factors including Lp(a)in CHD patients with VHD,and to explore the correlation between Lp(a)and VHD in Chinese patients with CHD.MethodsIn this study,a retrospective case-control study was conducted to enroll 343 patients who were hospitalized in Nanfang Hospital from January 2013 to December 2019,underwent eight blood lipid tests and color Doppler echocardiography,and completed coronary angiography for the first time with diagnosed CHD.According to the results of color Doppler echocardiography,patients were divided into two groups:VHD(+)group and non-VHD(VHD(-))group.The differences of clinical baseline data,Lp(a)level,other blood lipid indexes,CRP and other test indexes between the two groups were compared.The simple Pearson correlation coefficient explored the association between the severity of VHD subgroup and all risk factors,including Lp(a).Stepwise linear multiple regression analysis was used to evaluate the factors with P<0.05 in Pearson correlation analysis,and to test the relationship between the risk factors including Lp(a)and the severity of VHD subgroup.ResultsIn patients with CHD,there was no significant difference in terms of serum Lp(a)level(31.76±28.07mg/dl vs.32.41±25.40mg/dl,P=0.129)between VHD(+)and VHD(-)group.Pearson correlation analysis showed that AS and MS were positively correlated with Lp(a)(P<0.05),respectively.Further multiple stepwise regression analysis showed that the severity of stenosis valvular heart disease(AS or MS),AS and MS was related to Lp(a),respectively.In CHD patients,the level of Lp(a)in AS,MS and stenosis valvular disease group was significantly higher than that in VHD(-)group(AS:34.75±32.36 mg/dL vs.32.41±25.40 mg/dL,P=0.010;MS:60.36±36.12 mg/dL vs.32.417±25.40 mg/dL,P=0.007;stenosis valvular heart disease:39.30±34.55 mg/dL vs.32.41±25.40 mg/dL,P<0.001).ConclusionIn CHD patients,AS and MS patients had significantly higher levels of serum Lp(a)compared with patients without VHD.In addition,the increased level of serum Lp(a)was associated with increased AS and MS risk.The findings of this study are expected to provide a new target for the prevention and treatment of AS and MS.