Plasma lipoprotein (a) and tissue plasminogen activator are associated with increased risk of atherosclerotic cardiovascular disease

Atherosclerotic cardiovascular disease (ASCVD) is the most common cause of mortality. Lipoprotein a (Lp(a)) is a low-density lipoprotein (LDL)-like particle with a similar structure to tissue plasminogen activator (t-PA) and it competes with plasminogen for its binding site leading to reduced fibrinolysis. The aim of this study was to assess association of Lp(a) and t-PA levels with risk of ASCVD and whether they are dependent on LDL levels. Patients who presented to the catheterization lab for assessment of coronary artery disease were included and stratified by their risk of ASCVD into low, moderate, high, and very high risk. Plasma levels of Lp(a) and t-PA levels were measured before catheterization. Consecutive patients (n = 362) were included. The mean age±sem was 52.28 ± 0.60 years. Plasma Lp(a) and t-PA levels were higher in very-high and high-risk patients relative to low-risk patients. Serum levels of triglyceride and high-density lipoprotein but not LDL were correlated with risk of ASCVD. Plasma Lp(a) and t-PA were not correlated or modified with LDL level. Plasma Lp(a) and t-PA levels were higher in patients undergoing coronary revascularization relative to patients having no intervention. Plasma t-PA level was higher in patients presented with myocardial infarction compared to those with angina. Multivariate analysis documented independent association of Lp(a) and t-PA with ASCVD risk. Plasma Lp(a) and t-PA levels are associated with increased ASCVDASCVD risk independent of LDL and could be used as predictors of atherosclerosis risk and in selecting patients who may benefit from coronary revascularization.