Mechanisms
Lp(a) predicts prior heart attack in patients with coronary spasm, a Japanese study across three patient groups (J Am Coll Cardiol 2000)
Original title: Lipoprotein(a) is a risk factor for occurrence of acute myocardial infarction in patients with coronary vasospasm
This study measured Lp(a) in 77 patients with coronary spasm without significant fixed stenosis, 177 with fixed stenosis without rest angina, and 81 controls without coronary disease, to test whether Lp(a) predicts acute myocardial infarction (AMI) in coronary spasm patients. Median Lp(a) was higher in coronary spasm patients (17 mg/dL) than controls (12 mg/dL, P<0.01), but lower than in fixed-stenosis patients (23 mg/dL, P<0.01). Elevated Lp(a) (above 25 mg/dL) was more common in fixed-stenosis patients (46%, P<0.01) but not coronary spasm patients (27%) compared with controls (21%). Among coronary spasm patients, elevated Lp(a) was more frequent in those with prior myocardial infarction (56% vs 21%, P<0.05), and patients with elevated Lp(a) had a higher rate of prior MI (41% vs 13%, P<0.05); multivariate analysis confirmed elevated Lp(a) as an independent predictor of prior MI (odds ratio 4.19, 95% CI 1.03-17.00). The findings show elevated Lp(a) is associated with prior myocardial infarction in coronary spasm patients, suggesting a role for Lp(a) in thrombotic coronary occlusion following coronary spasm.
Original abstract
Objectives: The purpose of this study is to determine whether lipoprotein(a) (Lp[a]) is an independent risk factor for coronary spasm and occurrence of acute myocardial infarction (AMI) in patients with coronary spasm.
Background: Although elevated serum Lp(a) levels are known to be associated with coronary atherosclerosis and AMI, the association between the elevated level of this lipoprotein and coronary spasm remains to be elucidated.
Methods: Serum Lp(a) levels were measured using a latex immunoassay in 77 patients with coronary spasm but without a significant (>75%) fixed coronary stenosis, including 16 with prior myocardial infarction (MI), in 177 patients with a fixed stenosis but without rest angina, including 114 with prior MI and in 81 control subjects without coronary artery disease.
Results: The serum Lp(a) level in patients with coronary spasm (median; 17 mg/dl) was higher (p < 0.01) than in control subjects (12 mg/dl) but lower (p < 0.01) than in patients with a fixed stenosis (23 mg/dl). The incidence of subjects with higher (>25 mg/dl) serum Lp(a) levels was higher in patients with a fixed stenosis (46%, p < 0.01) but not in patients with coronary spasm (27%), compared with control subjects (21%). Among the patients with coronary spasm, the incidence of higher Lp(a) levels was higher in patients with than in those without a history of prior MI (56% vs. 21%, p < 0.05). The patients with higher Lp(a) levels had a higher incidence of prior MI than those without (41% vs. 13%, p < 0.05). The multivariate analysis confirmed that higher serum Lp(a) level is an independent determinant for prior MI in these patients (odds ratio, 4.19; 95%, confidence interval, 1.03 to 17.00).
Conclusions: Elevated serum level of Lp(a) was found to be associated with a history of prior MI in patients with coronary spasm, suggesting that Lp(a) may play an important role in the genesis of thrombotic coronary occlusion and the occurrence of AMI subsequent to coronary spasm.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.