Lp(a) is Predictor of Coronary Artery Disease in Pre-menopausal but not in Post-menopausal Women

Coronary artery disease (CAD) risk increases in women after menopause. Although numerous reports suggest that lipid profile worsening after menopause may be associated with an increase in CAD among women, there have been few studies that discussed the contribution of Lp(a). To examine the association between CAD and Lp(a) in pre-menopausal (PR, <55 yo) and post-menopausal (PO, ≥55 yo) women, we evaluated Lp(a) levels and other risk factor prevalence in 180 female patients (20 to 77 yo) with angiographically defined CAD. Six risk factors were assessed: hyper-Lp(a)emi (Hi-Lp(a), Lp(a) ≥ 30 mg/dl), hyper-LDLemi (Hi-LDL, LDL ≥ 160 mg/dl), hypo-HDLemi (Lo-HDL, HDL < 35 mg/dl), hypertension, diabetes, and smoking. Cases were defined as those who had ≥1 coronary artery with >50% stenosis. There were more patients with Hi-Lp(a) (61%* vs 27%), Hi-LDL (61%** vs 5%) and smoking (61%** vs 9%) in PR cases (n = 18) as compaved with those in PR controls (n = 22). PO cases (n = 93) had more Lo-HDL (15%* vs 2%), diabetes (33%** vs 13%) and smokers (61%** vs 9%) than PO controls (n = 47) did. The median Lp(a) of PR cases was higher than that of PR controls (38.8*, 22.7 mg/dl), and they increased with number of diseased arteries. In contrast, there was no difference in the Lp(a) levels between PO cases and PO controls (21.7, 25.2 mg/dl). Logistic regression model also revealed that Hi-Lp(a) was an independent predictor of CAD after controlling for Hi-LDL, Lo-HDL, hypertension, diabetes and smoking among PR (B = 2.44, SE = 1.20, p < 0.05), but not among PO. Our dat suggests that Lp(a) may be strong risk factor for CAD in pre-menopausal women, and in post-menopausal women other risk factors, such as an estrogen deficiency, may play an important role. (*p < 0.05, **p < 0.01).