Association between Lipoprotein(a) Concentration and Adverse Cardiovascular Events in Vietnamese Patients with Acute Myocardial Infarction: An observational cohort study

Abstract

Background: This study aimed to evaluate serum lipoprotein(a) concentrations in Vietnamese patients with acute myocardial infarction and to investigate the relationship between high serum concentrations of lipoprotein(a) and major adverse cardiovascular events after acute myocardial infarction. Methods: We conducted a prospective cohort study that included data from 199 patients with acute myocardial infarction admitted to the Cardiology Department, Cho Ray Hospital, Vietnam. Data on demographics, and hematologic, and biochemical blood test results, including serum lipoprotein(a) concentrations and coronary angiography results, were collected. All major cardiovascular adverse events (MACE) were defined as cardiovascular mortality, non-fatal myocardial infarction, and non-fatal ischemic stroke in hospital 30 days after discharge. Results: In patients with acute myocardial infarction, serum concentrations of lipoprotein(a) were not normally distributed, and skewed to the right, with a median of 17.8 mg/dL, interquartile range (IQR) 7.6-34.5 mg/dL. Overall, 29.1%, 17.1%, 12.6%, and 6.5% of patients had a serum lipoprotein(a) concentration of ≥ 30, ≥ 50, ≥ 70, and ≥ 90 mg/dL, respectively. Patients with a serum lipoprotein(a) concentration of ≥ 50 mg/dL had a higher BMI (p = 0.04), a higher rate of non-ST-elevation myocardial infarction (NSTEMI) (p = 0.035), a lower GRACE score (p = 0.038), higher levels of total cholesterol, high-density lipoprotein cholesterol (HDL-C) and unadjusted low-density lipoprotein cholesterol (LDL-C) concentrations (p = 0.002, 0.015, < 0.001, respectively), and a higher rate of three-vessel disease (p = 0.023) compared to patients with a serum lipoprotein(a) concentration < 50 mg/dL. The relative risk between lipoprotein(a) ≥ 50 mg/dL and MACE was 2.37. Conclusions: Patients with acute myocardial infarction and serum lipoprotein(a) ≥ 50 mg/dL were more likely to have NSTEMI and a lower GRACE score. Lipoprotein(a) ≥ 50 mg/dL at the time of acute myocardial infarction was not associated with in-hospital MACE, 30-days-after-discharge MACE, nor with all-cause mortality within 6 months of study follow-up.

Prognostic value of elevated lipoprotein (a) in patients with acute coronary syndromes: a systematic review and meta-analysis

“…Following the elimination of duplicate publications, a meticulous review of titles and abstracts resulted in the inclusion of 2024 articles for further consideration. Ultimately, 18 full-text articles, encompassing a total of 18,168 patients (13,843 male, 4,325 female), were selected for the comprehensive pooled analysis ( 20 – 23 , 25 – 28 , 33 – 42 ). Of these articles, 5 were prospective cohort studies ( 21 , 23 , 34 , 35 , 40 ), 10 were retrospective cohort studies ( 20 , 22 , 25 , 26 , 28 , 33 , 36 – 39 ), and 3 were observational cohorts ( 4 , 27 , 41 ).…”

“…Ultimately, 18 full-text articles, encompassing a total of 18,168 patients (13,843 male, 4,325 female), were selected for the comprehensive pooled analysis ( 20 – 23 , 25 – 28 , 33 – 42 ). Of these articles, 5 were prospective cohort studies ( 21 , 23 , 34 , 35 , 40 ), 10 were retrospective cohort studies ( 20 , 22 , 25 , 26 , 28 , 33 , 36 – 39 ), and 3 were observational cohorts ( 4 , 27 , 41 ). The encompassed investigations in this analysis spanned the period from 2009 to 2023.…”

“…The median (range) quality score, indicative of methodological rigor, was determined to be 7 (5–9). Notably, 14 studies were acknowledged for their high quality, indicating the strength of their methodologies and findings within the scope of this comprehensive analysis ( 21 , 23 , 26 – 28 , 33 – 40 , 42 ). The quality assessment details of all eligible are presented in Supplementary Table S3 .…”

“…Fourteen studies ( 20 – 23 , 25 , 26 , 28 , 33 , 36 – 41 ) investigated the prognostic significance of elevated Lp (a) levels in relation to MACE ( Figure 2A ). The meta-analysis utilizing a random-effects model revealed a pooled HR of 1.26 (95% CI: 1.17–1.35) for high compared to low category of Lp (a) levels, demonstrating a statistically significant association.…”

“…Consistent findings were reported by Andrea Kallmeyer et al and Si-qi Yang et al ( 21 , 22 ). Conversely, a Vietnam-based observational cohort study ( 23 ) yielded disparate results, suggesting no correlation between Lp (a) levels ≥ 50 mg/dl during AMI and MACE or all-cause mortality. No comprehensive systematic review or meta-analysis has yet assessed the prognostic significance of elevated Lp (a) levels in ACS patients regarding MACE and all-cause mortality.…”