Lipoprotein(a), Immune Cells and Cardiovascular Outcomes in Patients with Premature Coronary Heart Disease

Abstract

The detection of lipoprotein(a) [Lp(a)] in the artery wall at the stage of lipid-bands formation may indicate that it participates in the atherosclerosis local nonspecific inflammatory process. Innate immune cells are involved in atherogenesis, with monocytes playing a major role in the initiation of atherosclerosis, while neutrophils can contribute to plaque destabilization. This work studies the relationship between Lp(a), immune blood cells and major adverse cardiovascular events (MACE) in patients with the early manifestation of coronary heart disease (CHD). The study included 200 patients with chronic CHD, manifested up to the age of 55 in men and 60 in women. An increased Lp(a) concentration [hyperLp(a)] was shown to predict cardiovascular events in patients with premature CHD with long-term follow-up. According to the logistic regression analysis results, an increase in the monocyte count with OR = 4.58 (95% CI 1.04–20.06) or lymphocyte-to-monocyte ratio with OR = 0.82 (0.68–0.99), (p < 0.05 for both) was associated with MACE in patients with early CHD, regardless of gender, age, classical risk factors, atherogenic lipoproteins concentration and statin intake. The combination of an increased monocyte count and hyperLp(a) significantly increased the proportion of patients with early CHD with subsequent development of MACE (p = 0.02, ptrend = 0.003). The odds of cardiovascular events in patients with early CHD manifestation were highest in patients with an elevated lymphocyte-to-monocyte ratio and an elevated Lp(a) level. A higher neutrophil blood count and an elevated neutrophil-to-lymphocyte ratio determined the faster development of MACE in patients with a high Lp(a) concentration. The data obtained in this study suggest that the high atherothrombogenicity of Lp(a) is associated with the “inflammatory” component and the innate immune cells involvement in this process. Thus, the easily calculated immunological ratios of blood cells and Lp(a) concentrations can be considered simple predictors of future cardiovascular events.

Elevated lipoprotein(a) as a predictor for coronary events in older men

“…Whilst absolute cutoffs may be beneficial for decision making within the clinic, a linear increase in atherosclerotic CVD risk has been observed with Lp(a) concentration, suggesting that even a modest increase in Lp(a) may be determinantal ( 23 ). Notably, within this study, the observation that no difference was found between low (<30 mg/dl) and elevated (30–50 mg/dl) Lp(a) in ACS risk differs from recent findings, where Lp(a) levels over 30 mg/dl contributed to an increased risk of coronary heart disease ( 44 ) and a linear relationship with both fatal and nonfatal cardiovascular risk ( 45 , 46 ). This may, in part, be due to the disparity in race between the two studies.…”

Lymphocyte‐to‐Monocyte Ratio Is Independently Associated with Progressive Infarction in Patients with Acute Ischemic Stroke

“…Cai et al found that a lower LMR at admission was independently associated with long-term all-cause mortality and major adverse cardiac events after discharge in patients with ST-elevation myocardial infarction [ 37 ]. However, the odds of cardiovascular events in patients with early coronary heart disease manifestations were the highest in patients with an elevated LMR [ 38 ]. Lombardi et al also found that a higher LMR is directly associated with any type of clinical diagnosis of dementia [ 39 ].…”

Neutrophil Count as Atrioventricular Block (AVB) Predictor following Pediatric Heart Surgery

“…Our analysis is based on a simple marker, easily obtained from whole blood count analysis, which serves as a predictive marker for perioperative significant AB block (2nd or 3rd degree requiring pacing). The relation between preoperative simple inflammatory markers and cardiovascular diseases progression has already been postulated [ 33 , 34 , 35 , 36 ]. We focused on preoperative inflammatory indices in children, as previous reports in adults linked postoperative complications to perioperative neutrophil activation [ 37 , 38 , 39 , 40 ].…”