Lipoprotein(a) and Cardiovascular Outcomes in Patients with Previous Myocardial Infarction: A Prospective Cohort Study

Abstract

Lipoprotein(a) [Lp(a)] has been documented to be associated with atherothrombotic diseases. However, the prognostic impact of Lp(a) on long-term clinical outcomes among patients with previous myocardial infarction (MI) remains unclear. In this prospective cohort study, we consecutively enrolled 3864 post-MI patients to assess the cardiovascular events (CVEs), including MI, ischemic stroke, and cardiac mortality. Lp(a) levels were determined using an immunoturbidimetry assay and the participants were categorized according to Lp(a) quartiles. Cox proportional hazards model was used to calculate hazard ratios (HR) with 95% confidence intervals (CI). During a median follow-up of 4.1 years, 331 (8.6%) CVEs were identified. Lp(a) was significantly higher in the patients with CVEs [25.17 (11.13-47.83) vs. 18.18 (7.90-40.30) mg/dL, p=0.001]. The cumulative rates of CVEs and cardiac mortality were significantly higher in patients with high Lp(a) levels (both log-rank p<0.001). Multivariate Cox regression analysis showed a significant correlation between Lp (a) levels treated as a natural logarithm-transformed continuous variable and increased CVEs (adjusted HR:1.22, 95%CI:1.09-1.35, p=0.001) or cardiac mortality (HR:1.30, 95%CI:1.14-1.48, p<0.001). The addition of Lp(a) to a prognostic model revealed a significant improvement in C-statistic, net reclassification and integrated discrimination. In conclusion, elevated levels of Lp(a) were indeed associated with long-term worse outcomes in patients with prior MI, suggesting a novel hint that the measurement of Lp(a) might help to risk stratification and future management in those high-risk individuals.

Circulating lipoprotein (a) and all-cause and cause-specific mortality: a systematic review and dose-response meta-analysis

“…Briefly, these studies have been published between 1998 and 2020. The association of Lp(a) concentration and all-cause or cause-specific mortality was reported in general or healthy populations [8,11,12,34,36,[58][59][60][61][62][63][64][65][66][67][68][69][70], individuals with CVD [13,14,30,67,69,[71][72][73][74][75][76][77][78][79][80][81][82][83][84], chronic renal failure (CRF) [27,[31][32][33], and DM [10,15,67,85,86]. One study was conducted in women only [78] and two in men only [64,68].…”

Circulating Total Bilirubin and Long-Term Prognosis in Patients With Previous Myocardial Infarction

“…Multiple nontraditional biomarkers have been identified and used for cardiovascular outcome prediction and risk stratification. 5 , 6 , 7 Clinically, circulating total bilirubin (TBil) has been traditionally considered a potentially toxic metabolite and a marker for the diagnosis of some liver diseases. 8 , 9 , 10 However, the latest evidence supports that TBil within the normal physiologic range is a potent endogenous antioxidant with anti-inflammatory, immunomodulatory, antithrombotic, and endocrine properties, 8 which may likely contribute to the protective effect on oxidative stress diseases including diabetes, 11 stroke, 12 peripheral arterial disease, 13 heart failure (HF), 14 and CVD.…”

Lp (a): An Independent Predictive Marker In Diseases

“…After adjusting for age and gender factors, multivariate regression analysis showed that LP (a) level was still signi cantly correlated with AS and myocardial infarction, but not with stroke. This suggests that the higher the level of LP (a) in patients, the greater the risk of AS and myocardial infarction, which is of certain signi cance for the prediction and prevention of these diseases [21] . At the same time, it may infer that when the disease develops to stroke, the level of LP (a) has a greater impact of age and gender.…”