Association Of Lipoprotein (a) And Coronary Artery Disease In Patients With Non-dialysis Chronic Kidney Disease

Aim:Lipoprotein(a)[Lp(a)]has been regared as a risk factor of cardiovascular disease.However,it’s role in Chronic Kidney Disease(CKD)patients has not been well understood.The aim of this study was to evaluate the association between Lp(a)concentration and the presence of Coronary Artery Disease(CAD),the number of coronary lesions and the severity of Coronary Artery Stenosis(CAS)in patients with non-dialysis CKD.Methods:This study collected patients who were diagnosed with CKD and underwent coronary artery angiography from August 2015 to January 2017 in Zhongda Hospital.The eGFR was calculated by the Chronic Kidney Disease Epidemiology Collaboration equation(CKD-EPI).The diagnosis of CAD was coronary artery stenosis greater than 50%in at least one main coronary artery,like the left main coronary artery(LM),the left anterior descending coronary artery(LAD),the left circumflex coronary artery(LCX)and the right coronary artery(RCA).CAD patients were divided into three groups,as single,double and three coronary artery lesions according to LM,LAD,LCX and RCA.Gensini score(GS)system was used to assess the severity of coronary stenosis.The association of Lp(a)with the presence of CAD and the severity of CAS were determined by multivariate logistic regression analysis.Results:1003 patients with non-dialysis CKD who underwent coronary angiography were enrolled in this cross-sectional study and 776 patients were diagnosed with CAD.The Lp(a)levels were significantly higher among the CAD group[271.50(168.00-459.25)vs.195.00(131.00-347.00)mg/L,P<0.001]and the eGFR levels were significantly lower in the CAD group(47.26±10.50 vs.50.50±8.87ml/min/1.73 m~2,P<0.001).Lp(a)Tertiles showed significant differences in the rate of CAD(P<0.001).The rate of CAD in Lp(a)Tertile 2 was significantly higher than Lp(a)Tertile 1(82.0%vs.67.2%,P<0.001)and the rate of CAD in Lp(a)Tertile 3was significantly higher than Lp(a)Tertile 1(83.0%vs.67.2%,P<0.001).There was no significant difference between Lp(a)Tertile 2 and Lp(a)Tertile 3(P>0.05).After adjusting for potential confounders,like age,sex,BMI,smoking,drinking,hypertension,diabetes mellitus,HDL-C,LDL-C,ApoA1,ApoB,albumin,fibrinogen,eGFR,uric acid,calcium and phosphorus,multivariate logistic regression analysis showed that Lp(a)Tertiles were associated with the presence of CAD independently[Tertile2 vs.Tertile1(Adjust OR=2.063,95%CI 1.394-3.053,P<0.001),Tertile3 vs.Tertile1(Adjust OR=2.022,95%CI 1.345-3.040,P=0.001)].Among 776 patients diagnosed with CAD,there were 65 with LM lesion,684with LCX lesion,458 with LCX lesion,455 with RCA lesion.The Lp(a)levels of patients with LM,LCX lesion greater than 50%were significantly higher(P<0.01).776 patients were divided into three groups,as the single coronary lesion group(n=225),the double coronary lesions group(n=215)and the three coronary lesions group(n=336).Three groups showed significant differences in the Lp(a)levels[246.00(162.50-401.00)mg/L vs.263.00(165.00-440.00)mg/L vs.305.00(188.50-510.00)mg/L;P<0.001].The Lp(a)levels in the group of three coronary lesions were significantly higher than the group of double coronary lesions(P<0.05)and the group of single coronary lesion(P<0.05).There were no significant differences between the group of double coronary lesions and the group of single coronary lesion.There were 829 patients diagnosed with CAS,after excluding 250 patients with histories of percutaneous coronary interventions,579 patients with CAS were divided into two groups,as the mild CAS group(GS 1–20,n=292)and the severe CAS group(GS>20,n=287).The levels of Lp(a)were significantly higher[288.00(191.00-424.00)vs.242.50(148.50-397.75)mg/L,P=0.001]and the eGFR levels were significantly lower(45.89±10.68 vs.48.79±10.04ml/min per 1.73 m~2,P=0.001)in the severe CAS group.After adjusting for potential confounders,like age,sex,BMI,smoking,drinking,hypertension,diabetes mellitus,HDL-C,LDL-C,ApoA1,ApoB,albumin,fibrinogen,eGFR,uric acid,calcium and phosphorus,Lp(a)Tertiles were independently correlated with the severe CAS[Tertile2 vs.Tertile1(Adjust OR=1.603,95%CI 1.040-2.472,P=0.033);Tertile3 vs.Tertile1(Adjust OR=1.743,95%CI 1.128-2.693,P=0.012)].Conclusions:Among non-dialysis CKD patients,higher Lp(a)levels were associated with the presence of CAD and the severity of CAS among patients with non-dialysis CKD independently.