© 1999 American Heart Association, Inc.
Atherosclerosis and Lipoproteins |
Fish Intake, Independent of Apo(a) Size, Accounts for Lower Plasma Lipoprotein(a) Levels in Bantu Fishermen of Tanzania
The Lugalawa Study
From the Department of Medicine, University of Washington, Seattle (S.M.M., H.K.); and Centro Regionale dell'Aterosclerosi, Venezia (G.B.B., G.C.); Istituto di Scienze Farmacologiche, Università di Milano, Milano (C.G.); and Dipartimento di Medicina Clinica e Sperimentale, Università di Padova, Padova (E.C., M.P., P.P.), Italy.
Correspondence to Dr Paolo Pauletto, Dipartimento di Medicina Clinica e Sperimentale, Università di Padova, via Giustiniani 2, 35128 Padova, Italy, E-mail pauletto{at}ux1.unipd.it
Abstract—Plasma lipoprotein(a) [Lp(a)] levels are largely genetically determined by sequences linked to the gene encoding apolipoprotein(a) [apo(a)], the distinct protein component of Lp(a). Apo(a) is highly polymorphic in length due to variation in the numbers of a sequence encoding the apo(a) kringle 4 domain, and plasma levels of Lp(a) are inversely correlated with apo(a) size. In 2 racially homogeneous Bantu populations from Tanzania differing in their dietary habits, we found that median plasma levels of Lp(a) were 48% lower in those living on a fish diet than in those living on a vegetarian diet. Considering the relationship between apo(a) size and Lp(a) plasma concentration, we have extensively evaluated apo(a) isoform distribution in the 2 populations to determine the impact of apo(a) size in the determination of Lp(a) values. The majority of individuals (82% of the fishermen and 80% of the vegetarians) had 2 expressed apo(a) alleles. Additionally, the fishermen had a high frequency of large apo(a) isoforms, whereas a higher frequency of small isoforms was found in the vegetarians. When subjects from the 2 groups were matched for apo(a) phenotype, the median Lp(a) value was 40% lower in Bantus on the fish diet than in those on the vegetarian diet. A significant inverse relationship was also found between plasma n-3 polyunsaturated fatty acids and Lp(a) levels (r=-0.24, P=0.01). The results of this study are consistent with the concept that a diet rich in n-3 polyunsaturated fatty acids, and not genetic differences, is responsible for the lower plasma levels of Lp(a) in the fish-eating Bantus and strongly suggest that a sustained fish-based diet is able to lower plasma levels of Lp(a).
Key Words: fish diet • lipoprotein(a) • apolipoprotein(a) isoforms • polyunsaturated fatty acids
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