Association of lipoprotein(a) with long‐term mortality following coronary angiography or percutaneous coronary intervention

Abstract

Background There is no consistent evidence to suggest the association of plasma lipoprotein(a) (Lp[a]) with long‐term mortality in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI). Hypothesis Level of Lp(a) is associated with long‐term mortality following CAG or PCI. Methods We enrolled 1684 patients with plasma Lp(a) data undergoing CAG or PCI between April 2009 and December 2013. The patients were divided into 2 groups: a low‐Lp(a) group (Lp[a] <16.0 mg/dL; n = 842) and a high‐Lp(a) group (Lp[a] ≥16.0 mg/dL; n = 842). Results In‐hospital mortality was not significantly different between the high and low Lp(a) groups (0.8% vs 0.5%, respectively; P = 0.364). During the median follow‐up period of 1.95 years, the high‐Lp(a) group had a higher long‐term mortality than did the low‐Lp(a) group (5.8% vs 2.5%, respectively; P = 0.003). After adjustment of confounders, multivariate Cox regression analysis revealed that a higher Lp(a) level was an independent predictor of long‐term mortality (hazard ratio: 1.96, 95% confidence interval: 1.07‐3.59, P = 0.029). Conclusions Our data suggested that an elevated Lp(a) level was significantly associated with long‐term mortality following CAG or PCI. However, additional larger multicenter studies will be required to investigate the predictive value of Lp(a) levels and evaluate the benefit of controlling Lp(a) levels for patients undergoing CAG or PCI.

High Level of Lipoprotein(a) as Predictor for Recurrent Heart Failure in Patients with Chronic Heart Failure: a Cohort Study

“…Currently, there are a few possible reasons for HF. Two possible mechanisms might explain this association between Lp(a) and HF occurrence:1) The increased HF risk due to elevated Lp(a) levels was partially mediated by myocardial infarction and/or aortic valve stenosis, 17,23 which can also be observed in our study. However, most part cannot be explained through both sides.…”

“…21 Another study suggested that an elevated Lp(a) level was significantly associated with long-term mortality following coronary angiography or percutaneous coronary intervention. 22 Although many studies have shown that LP(a) is an independent risk factor for adverse cardiac and cerebrovascular outcomes, limited data are available on the association between baseline Lp(a) levels and recurrent HF. In our study, we showed that baseline levels of Lp(a) ≥ 20.6 mg/dL was associated with significantly increased risk of recurrent HF with an HR of 2.720 (95% CI, 1.730-4.277; p<0.0001) in patients with chronic HF due to CHD during the one-year follow-up, even after adjustment for major covariables.…”

Prognostic value of lipoprotein (a) level in patients with coronary artery disease: a meta-analysis

“…Four studies [9, 15, 21, 22] reported the association between elevated lipoprotein(a) level and risk of all-cause mortality (Fig. 3).…”

Association between proprotein convertase subtilisin/kexin type 9 and late saphenous vein graft disease after coronary artery bypass grafting: a cross-sectional study

“…The mechanism of lipoprotein (a) on atherogenesis is multifactorial and includes formation of atherosclerotic plaque, interference with plasminogen activation, disrupting endothelial function and promoting phospholipid oxidation. 47 …”