Lipoprotein(a) as a risk predictor for cardiac mortality in patients with acute coronary syndromes

Abstract

Aims Raised lipoprotein(a) concentrations are considered to be a risk factor for atherothrombotic diseases. We examined whether baseline concentrations were a risk factor for an adverse outcome in patients admitted with acute coronary syndromes. Methods and ResultsFive hundred and nineteen patients admitted with suspected acute coronary syndromes were studied and followed prospectively for a median of 3 years. The prognostic significance of a baseline lipoprotein(a) concentration of d30 mg . dl 1 or lower for subsequent cardiac death was assessed in patients with myocardial infarction (266) and unstable angina (197) and compared with other variables in regression models. In patients with myocardial infarction, a baseline lipoprotein(a) concentration of d30 mg . dl 1 was associated with a 62% increase in subsequent cardiac death compared to the lower concentration group (29·8% vs 18·6%, Log rank P=0·04). In a multivariate regression model a baseline lipoprotein(a) concentration of d30 mg . dl 1 retained its significance as an independent predictor of cardiac death (P=0·037). In patients with unstable angina, baseline concentrations of d7·9 mg . dl 1 were found to be significant predictors of cardiac death in univariate (P=0·021) and multivariate (P=0·035) regression models.Conclusion Baseline lipoprotein(a) concentrations in patients admitted with acute coronary syndromes are associated with an increased risk of cardiac death. For patients with myocardial infarction a concentration of d30 mg . dl 1 appears appropriate as a risk discriminator; for patients admitted with unstable angina, however, much lower concentrations of lipoprotein(a) appear to be prognostically important.

Lipoprotein(a) Levels and Recurrent Vascular Events After First Ischemic Stroke

“…Another study investigated cardiac mortality in patients with acute coronary syndrome and found a 62% increase in risk with Lp(a) of >30 mg/dL. 26 In the population-based ARIC study (Atherosclerosis Risk in Communities), patients with known cardiovascular disease and elevated Lp(a) levels had an increased risk of recurrent events including MI and stroke. In multivariate analysis, however, Lp(a) remained a significant risk factor for CHD recurrence, but not for the composite end point of CHD and stroke.…”

The Attack on Coronary Disease: Should it be before, during or after?

“…We also found poor outcome in patients with high lipoprotein (a) [5,6,7]. Our other anxiety is about the use of statins in primary prevention, as we have observed serious side effects of these drugs, which not only leach lipid from fatty arterial lesions but also from normal cell membranes, leading to muscular and neurological defects.…”

Predicting Prognosis in Acute Coronary Syndromes: Makeover Time for TIMI and GRACE?

“…15 In a small study of patients with ACS followed for a median of 3 years, high Lp(a) levels predicted cardiac death. 16 The utility of Lp(a) in predicting events after ACS needs to be assessed in larger studies and needs to be shown to be superior to other variables before it is adopted for clinical use. Lp(a) is attractive because it is actionable; specifically, PCSK9 inhibitors reduce Lp(a) levels by up to 30%.…”