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Higher prevalence of coronary microvascular dysfunction in asymptomatic individuals with high levels of lipoprotein(a) with and without heterozygous familial hypercholesterolaemia

Wodaje, Tigist ; Mahdi, Ali ; Venkateshvaran, Ashwin LU orcid ; Häbel, Henrike ; Zenlander, Robin ; Gaylard, Benjamin ; Angelin, Bo ; Pernow, John and Brinck, Jonas (2024) In Atherosclerosis 389.
Abstract

Background and aims: Microvascular dysfunction underlies many cardiovascular disease conditions; little is known regarding its presence in individuals with high levels of lipoprotein(a) [Lp(a)]. The aim of the present study was to determine the frequency of microvascular dysfunction among such subjects with and without concomitant familial hypercholesterolemia (FH). Methods: Four groups of asymptomatic individuals aged 30–59 years, without manifest cardiovascular disease, were recruited (n = 30 per group): controls with Lp(a) < 30 nmol/L, mutation-confirmed FH with Lp(a) < 30 nmol/L, or >125 nmol/L, and individuals with isolated Lp(a) > 125 nmol/L. Participants underwent evaluation of myocardial microvascular function by... (More)

Background and aims: Microvascular dysfunction underlies many cardiovascular disease conditions; little is known regarding its presence in individuals with high levels of lipoprotein(a) [Lp(a)]. The aim of the present study was to determine the frequency of microvascular dysfunction among such subjects with and without concomitant familial hypercholesterolemia (FH). Methods: Four groups of asymptomatic individuals aged 30–59 years, without manifest cardiovascular disease, were recruited (n = 30 per group): controls with Lp(a) < 30 nmol/L, mutation-confirmed FH with Lp(a) < 30 nmol/L, or >125 nmol/L, and individuals with isolated Lp(a) > 125 nmol/L. Participants underwent evaluation of myocardial microvascular function by measuring coronary flow reserve (CFR) using transthoracic Doppler echocardiography, and of peripheral microvascular endothelial function by peripheral arterial tonometry. Results: The groups were balanced in age, sex, and body mass index. Each of the three dyslipoproteinaemic groups had a greater proportion of individuals with impaired coronary flow reserve, 30%, compared to 6.7% of controls (p = 0.014). The median CFR levels did not differ significantly between the four groups, however. Cholesterol-lowering treatment time was longer in the individuals with normal than in those with impaired CFR in the FH + Lp(a) > 125 group (p = 0.023), but not in the group with FH + Lp(a) < 30 (p = 0.468). There was no difference in peripheral endothelial function between the groups. Conclusions: Coronary microvascular dysfunction is more prevalent in asymptomatic individuals with isolated Lp(a) elevation and in heterozygous FH both with and without high Lp(a) compared to healthy controls. Cholesterol-lowering treatment could potentially prevent the development of microvascular dysfunction.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Coronary flow reserve, Endothelial dysfunction, Familial hypercholesterolaemia, lipoprotein(a), Microvascular dysfunction, Reactive hyperaemia index
in
Atherosclerosis
volume
389
article number
117439
publisher
Elsevier
external identifiers
  • scopus:85182379344
  • pmid:38219650
ISSN
0021-9150
DOI
10.1016/j.atherosclerosis.2023.117439
language
English
LU publication?
yes
id
049f72df-e57f-4a5a-b413-276f8a3a9450
date added to LUP
2024-04-11 12:47:49
date last changed
2025-10-14 10:49:33
@article{049f72df-e57f-4a5a-b413-276f8a3a9450,
  abstract     = {{<p>Background and aims: Microvascular dysfunction underlies many cardiovascular disease conditions; little is known regarding its presence in individuals with high levels of lipoprotein(a) [Lp(a)]. The aim of the present study was to determine the frequency of microvascular dysfunction among such subjects with and without concomitant familial hypercholesterolemia (FH). Methods: Four groups of asymptomatic individuals aged 30–59 years, without manifest cardiovascular disease, were recruited (n = 30 per group): controls with Lp(a) &lt; 30 nmol/L, mutation-confirmed FH with Lp(a) &lt; 30 nmol/L, or &gt;125 nmol/L, and individuals with isolated Lp(a) &gt; 125 nmol/L. Participants underwent evaluation of myocardial microvascular function by measuring coronary flow reserve (CFR) using transthoracic Doppler echocardiography, and of peripheral microvascular endothelial function by peripheral arterial tonometry. Results: The groups were balanced in age, sex, and body mass index. Each of the three dyslipoproteinaemic groups had a greater proportion of individuals with impaired coronary flow reserve, 30%, compared to 6.7% of controls (p = 0.014). The median CFR levels did not differ significantly between the four groups, however. Cholesterol-lowering treatment time was longer in the individuals with normal than in those with impaired CFR in the FH + Lp(a) &gt; 125 group (p = 0.023), but not in the group with FH + Lp(a) &lt; 30 (p = 0.468). There was no difference in peripheral endothelial function between the groups. Conclusions: Coronary microvascular dysfunction is more prevalent in asymptomatic individuals with isolated Lp(a) elevation and in heterozygous FH both with and without high Lp(a) compared to healthy controls. Cholesterol-lowering treatment could potentially prevent the development of microvascular dysfunction.</p>}},
  author       = {{Wodaje, Tigist and Mahdi, Ali and Venkateshvaran, Ashwin and Häbel, Henrike and Zenlander, Robin and Gaylard, Benjamin and Angelin, Bo and Pernow, John and Brinck, Jonas}},
  issn         = {{0021-9150}},
  keywords     = {{Coronary flow reserve; Endothelial dysfunction; Familial hypercholesterolaemia; lipoprotein(a); Microvascular dysfunction; Reactive hyperaemia index}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Atherosclerosis}},
  title        = {{Higher prevalence of coronary microvascular dysfunction in asymptomatic individuals with high levels of lipoprotein(a) with and without heterozygous familial hypercholesterolaemia}},
  url          = {{http://dx.doi.org/10.1016/j.atherosclerosis.2023.117439}},
  doi          = {{10.1016/j.atherosclerosis.2023.117439}},
  volume       = {{389}},
  year         = {{2024}},
}