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Abstract Background: Elevated lipoprotein(a) and xanthelasma palpebrarum ( as a cutaneous marker of coronary artery disease) are important risk factors for coronary artery disease (CAD). Lp(a) mediates cardiovascular risk through prothrombotic, proinflammatory, and proatherogenic properties. The association of Lp(a) and xanthelasma with angiographic disease severity and complexity in patients with CAD has yet to be established. Objective: To investigate the relationship of Lp(a), xanthelasma palpebrarum and severity and complexity of CAD using coronary angiography. Methods: Plasma Lp(a) levels were consecutively measured by an automated latex-enhanced immunoassay in 86 patients(43 xanthelasmtic patients scheduled for coronary angiography and 43 nonxanthelasmatic patients scheduled for coronary angiography. Elevated Lp(a) was defined as >25 mg/L. Demographical, biochemical, and clinical data were retrospectively collected from medical records. Coronary Angiography was independently assessed by 2 observers. Results: Patients were subdivided into 2 groups (group A: ْanthelasmatic patients and group B: nonxanthelasmatic patients). The proportion of xanthelasmatic patients with elevated Lp(a) were significantly higher in patients with CAD (P <0.0001). In multivariate analysis (adjusting for age, diabetes, hypertension, and previous coronary event), xanthelasmatic patients with elevated Lp(a) remained significant, independent predictors of severity and complexity of CAD(P <0.0001 and 0.007 respectively). while nonxanthelasmatic patients with nonelevated Lp(a) were predominantly in the lowest risk for CAD. Conclusion: In patients with xanthelasma palpebrarum and elevated Lp(a) were significant, independent predictors of the severity of CAD. xanthelasmatic patients should be routinely screened for Lp-a |