Lipids and lipoprotein(a) as risk factors for vascular disease in patients on renal replacement therapy

A large cohort of patients on renal replacement therapy werescreened for the presence of symptomatic arterial disease affectingthe coronary, cerebral or peripheral circulations. Ninety-twoof 325 patients were found to have vascular disease. Those withvascular disease had significantly higher median lipoprotein(a)[Lp(a)] levels than those without (38.4 vs 14.2 mg/dl, P<0.001),with a preponderance of Lp(a) levels greater than 30 mg/dl (58%vs 25% P<0.001). Apolipoprotein(a) [apo(a)] isoform distributionwas similar between the groups, but those with vascular diseasehad higher Lp(a) levels in the S2, S3/S4 and S4 isoform types.Comparison of 76 matched pairs of patients confirmed elevatedLp(a) levels in those with vascular disease. These patientsalso had significantly higher total cholesterol (6.66 vs 6.02mmol/l) and low-density lipoprotein cholesterol (4.49 vs 3.86mmol/l). Only Lp(a) was independently associated with vasculardisease (P=0.02). Elevated Lp(a) levels are significantly associatedwith the presence of vascular disease in patients on renal replacementtherapy and may constitute another risk factor for the developmentof such disease in these patients.