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Lipoproteina (a) e arteriopatia periferica

L'arteriopatia obliterante in genere non riceve molta attenzione da parte del clinico anche se per la sua prevalenza e per i danni che ne derivano dovrebbe essere più attentamente ricercata. La metodica diagnostica è semplice, alla portata di tutti e piuttosto affidabile. Questo studio longitudinale, condotto su una popolazione anziana allo scopo di verificare se la lipoproteina (a) sia o meno associata alla presenza o alla comparsa nel tempo di arteriopatia obliterante, ha effettivamente dimostrato che alti livelli plasmatici di lipoproteina (a) si accompagnavano ad un indice caviglia-braccio ridotto. La relazione era graduale, cioè ai livelli più alti di lipoproteina (a) corrispondeva una più marcata diminuzione dell'indice caviglia-braccio, cioè un danno arterioso più grave. Nel corso di questi ultimi anni, la relazione tra lipoproteina (a) e rischio cardiovascolare ha vissuto alterne vicende, ma ora appare piuttosto chiaro che il livello plasmatico di lipoproteina (a) è fortemente predittivo almeno della cardiopatia ischemica e dell'ictus cerebrale. Adesso si aggiunge anche l'arteriopatia periferica la cui relazione con la lipoproteina (a) è rimasta a lungo controversa.

Lipoprotein(a), inflammation, and peripheral arterial disease in a community-based sample of older men and women (the InCHIANTI study)

Volpato S, Vigna GB, McDermott MM, Cavalieri M, Maraldi C, Lauretani F, Bandinelli S, Zuliani G, Guralnik JM, Fellin R, Ferrucci L.

Am J Cardiol 2010;105:1825-30

Lipoprotein(a) (Lp[a]) may represent an independent risk factor for peripheral arterial disease of the lower limbs (LL-PAD), but prospective data are scant. We estimated the association between baseline Lp(a) with prevalent and incident LL-PAD in older subjects from the InCHIANTI Study. LL-PAD, defined as an ankle-brachial index <0.90, was assessed at baseline and over a 6-year follow-up in a sample of 1,002 Italian subjects 60 to 96 years of age. Plasma Lp(a) and potential traditional and novel cardiovascular risk factors (including a score based on relevant inflammatory markers) were entered in multivariable models to assess their association with prevalent and incident LL-PAD. At baseline, Lp(a) concentration was directly related to the number of increased inflammatory markers (p <0.05). There were 125 (12.5%) prevalent cases of LL-PAD and 57 (8.3%) incident cases. After adjustment for potential confounders, participants in the highest quartile of the Lp(a) distribution (>/=32.9 mg/dl) were more likely to have LL-PAD compared to those in the lowest quartile (odds ratio [OR] 1.83, 95% confidence interval [CI] 1.01 to 3.33). The association was stronger (OR 3.80, 95% CI 1.50 to 9.61) if LL-PAD was defined by harder criteria, namely an ankle-brachial index <0.70. Compared to subjects in the lowest Lp(a) quartile, those in the highest quartile showed a somewhat increased risk of incident LL-PAD (lowest quartile 7.7%, highest quartile 10.8%), but the association was not statistically significant (OR 1.52, 95% CI 0.71 to 3.22). In conclusion, Lp(a) is an independent LL-PAD correlate in the cross-sectional evaluation, but further prospective studies in larger populations, with longer follow-up and more definite LL-PAD ranking, might be needed to establish a longitudinal association.

Am J Cardiol 2010;105:1825-30