{
  "abstract": "Introduction Although low-density lipoprotein cholesterol (LDL-C) is established as the primary cardiovascular disease (CVD) risk factor, some individuals with LDL-C within desirable limits still develop coronary artery disease (CAD). Lipoprotein(a) (Lp(a)) has emerged as a genetically determined independent risk factor for CVD. This study aims to investigate Lp(a) by determining its association with coronary artery stenosis severity, identifying its ethnic-specific genetic determinants and assessing its relationship with an energy-dense dietary pattern.Methods and analysis The PUTRA-CV study is a 3-year, multicentre, case-control observational study involving adult patients who have undergone coronary angiography. The primary outcome is the association between Lp(a) levels and the severity of angiographic CAD (assessed by Gensini or Syntax score). Secondary outcomes include the frequencies of Lp(a)-associated single nucleotide polymorphisms (SNPs) (rs10455872 and rs3798220) and the association between dietary patterns and Lp(a) levels. Lp(a) will be measured using a particle-enhanced immunoturbidimetric method, and SNPs will be genotyped using high-resolution melting. Dietary intake will be assessed using a validated semiquantitative food frequency questionnaire. Data will be analysed using SPSS. Descriptive statistics will be used to summarise population characteristics. Bivariate analyses will use chi-square (χ2), independent t-tests or Mann-Whitney U tests as appropriate. The independent association between Lp(a) and coronary artery stenosis severity will be determined using multivariable logistic regression, adjusting for confounders. Empirically driven dietary patterns will be derived using reduced rank regression, and their association with Lp(a) will be assessed. For genetic analysis, allele frequencies of the LPA SNPs rs10455872 and rs3798220 will be calculated and compared between cases and controls.Ethics and dissemination Ethical approval has been obtained from the ethics committees of the Ministry of Health Malaysia (NMRR ID-24-00877-2ID-IIR), Universiti Putra Malaysia (JKEUPM-2024–246), Universiti Teknologi MARA (REC/07/2024-OT/FB/2) and Universiti Malaya Medical Centre (MREC ID NO: 2 02 453–13692). The findings will be disseminated via peer-reviewed journals and conferences.",
  "authors": [
    {
      "affiliations": [
        "Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia"
      ],
      "name": "Sangitha Pannirselvam"
    },
    {
      "affiliations": [
        "Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia",
        "Department of Pathology, Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, Serdang, Selangor, Malaysia",
        "Malaysian Research Institute on Ageing (MyAgeing™), Universiti Putra Malaysia, Serdang, Selangor, Malaysia"
      ],
      "name": "Subashini C Thambiah"
    },
    {
      "affiliations": [
        "Division of Nutrition, Dietetics & Food Science, School of Health Sciences, IMU University, Kuala Lumpur, Wilayah Persekutuan, Malaysia"
      ],
      "name": "Geeta Appannah"
    },
    {
      "affiliations": [
        "Malaysian Research Institute on Ageing (MyAgeing™), Universiti Putra Malaysia, Serdang, Selangor, Malaysia",
        "Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia",
        "Brain and Mental Health Research Advancement and Innovation Networks (PUTRA BRAIN), Universiti Putra Malaysia, Serdang, Selangor, Malaysia"
      ],
      "name": "King Hwa Ling"
    },
    {
      "affiliations": [
        "Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia",
        "Department of Pathology, Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, Serdang, Selangor, Malaysia"
      ],
      "name": "Intan Nureslyna Samsudin"
    },
    {
      "affiliations": [
        "School of Medicine, University of Western Australia, Perth, Western Australia, Australia",
        "Department of Clinical Biochemistry, PathWest Laboratory Medicine Western Australia, Royal Perth Hospital and Fiona Stanley Hospital Network, Perth, Western Australia, Australia"
      ],
      "name": "Amanda J Hooper"
    },
    {
      "affiliations": [
        "Universiti Teknologi MARA Specialist Centre, Sungai Buloh, Selangor, Malaysia"
      ],
      "name": "Mohd Rahal Yusoff"
    },
    {
      "affiliations": [
        "Universiti Teknologi MARA Specialist Centre, Sungai Buloh, Selangor, Malaysia"
      ],
      "name": "Ahmad Firdaus Zakaria"
    },
    {
      "affiliations": [
        "Chemical Pathology Unit, Department of Clinical Diagnostic Laboratories, Hospital Al-Sultan Abdullah, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia"
      ],
      "name": "Rafezah Razali"
    },
    {
      "affiliations": [
        "Department of Cardiology, Sultan Idris Shah Serdang Hospital Heart Centre, Serdang, Selangor, Malaysia"
      ],
      "name": "Glendon Lau Seng Kiong"
    },
    {
      "affiliations": [
        "Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia",
        "Department of Pathology, Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, Serdang, Selangor, Malaysia"
      ],
      "name": "Siti Yazmin Zahari Sham"
    },
    {
      "affiliations": [
        "Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia",
        "Department of Pathology, Hospital Sultan Abdul Aziz Shah, Universiti Putra Malaysia, Serdang, Selangor, Malaysia"
      ],
      "name": "Yin Ye Lai"
    },
    {
      "affiliations": [
        "Chemical Pathology Unit, Department of Clinical Diagnostic Laboratories, Hospital Al-Sultan Abdullah, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia",
        "Cardiovascular Advancement Research Excellence Institute (CARE-i), Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia",
        "Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia"
      ],
      "name": "Thuhairah Hasrah Abdul Rahman"
    },
    {
      "affiliations": [
        "Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Wilayah Persekutuan, Malaysia"
      ],
      "name": "Imran Zainal Abidin"
    }
  ],
  "title": "PUTRA-CV study protocol: a multicentre observational study of ethnic-specific genetic variants and dietary patterns in relation to lipoprotein(a) levels and their association with coronary artery disease severity in Malaysian adults",
  "uid": "2fe88662-89bb-5273-99c4-39e9d16e9781"
}