Lipoprotein(a) is a superior serum marker for CHD risk compared with apoproteins and traditional lipid profile in Malaysian adult males

Abstract

Out of 561 Malays, Chinese and Indian adult males, aged 25-79 years, screened at a cardiology clinic, 106 were identified as suffering from coronary heart disease (CHD) while the remaining 455 CHD-free males served as controls in the study. Body mass index (BMI) and waist-hip ratio (WHR) were recorded for all subjects while a fasting blood specimen collected from each subject was analysed for serum total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDLC), low density lipoprotein cholesterol (LDLC), apoprotein (apo) A-1, apo B, and lipoprotein(a) [Lp(a)]. The results of CHD risk assessment showed chat the traditional serum lipid and lipoprotein risk factors namely, TC, LDLC, and TG had little diagnostic value in the present population (odds ratio, i.e. OR, all <1.5), while the negative risk factors, HDLC and apo A-1, were equally unimpressive (OR= 0.75 and 1.00, respectively). On the other hand, the clinical value of Lp(a) and apo B as serum markers for CHD risk appeared impressive, being significantly higher (p<0.05) in the CHD group compared to controls (25.8 vs 12.5 mg/dl and 107 vs 87 mg/dl, respectively). Comparatively high OR values for Lp(a) [4.48] and apo B (3.85), supported by results of receiver-operating characteristics (ROC) plots, indicate a strong positive association of these two risk factors with CHD. Overall, Lp(a) seemed by far, the most reliable of the biochemical markers for CHD risk in the present Malaysian subject population, and the use of the index in routine screening should be given serious consideration.