Lipoprotein(a) plasma levels are not associated with survival after acute coronary syndromes: An observational cohort study

Roth, Christian; Krychtiuk, Konstantin A.; Gangl, Clemens; Schrutka, Lore; Distelmaier, Klaus; Wojta, Johann; Hengstenberg, Christian; Berger, Rudolf; Speidl, Walter S.

doi:10.1371/journal.pone.0227054

Cited by 17 publications

(17 citation statements)

References 24 publications

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“…We did not study Lp(a) genotypes, but other data suggest that Lp(a) mass or molar concentrations are better predictors of CVD risk [37]. Lp(a) levels may be lowered during the acute periods of AMI [38]. Despite this, the significant statistical associations that we found are supportive of Lp(a) as an important cardiovascular risk factor.…”

Section: Tablementioning

confidence: 59%

Lipoprotein(a) as predictor of coronary artery disease and myocardial infarction in a multi-ethnic Asian population

Loh

Chang

et al. 2022

Atherosclerosis

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Background and aims: The role of Lp(a) in multi-ethnic Asian populations with coronary artery disease (CAD) has not been well established. The aims of this study were (i) to investigate whether Lp(a) is a predictor of CAD, and (ii) amongst patients with CAD, to ascertain whether Lp(a) is a predictor of acute myocardial infarction (AMI) and severity of CAD. Methods: We compared three cardiovascular phenotypes from patients recruited at coronary angiography. CAD was defined as ≥50% coronary artery stenosis and subdivided into a group with AMI history (CAD+AMI+) and a group without (CAD+AMI-). Minimal CAD group (CAD-) was defined as normal or <30% coronary artery stenosis and no AMI. The severity of CAD was defined using the modified Gensini score. Results: We studied 2025 patients comprising 94.5% men and 61.4% of Chinese ethnicity. The median Lp(a) level was highest in CAD+AMI+, followed by CAD+AMI-and CAD-(26.2, 20.1, and 15.8 nmol/L respectively). Similarly, the frequency of patients with Lp(a) ≥120 nmol/L were in the same order (11.8%, 9.1% and 2.4%). Lp (a) levels were highest among Asian Indians, followed by Malays and Chinese patients (p < 0.001). Lp(a) levels and Lp(a) ≥120 nmol/L were significant predictors of CAD (Odds ratio (OR) = 1.12 per 10 nmol/L increment, p < 0.001, and OR = 5.41 p = 0.004 respectively). Among patients with CAD, higher Lp(a) levels were associated with increased AMI risk (OR = 1.02 per 10 nmol/L increment, p = 0.024). Lp(a) ≥120 nmol/L was positively associated with CAD severity (p = 0.020). Conclusions: Plasma Lp(a) concentration is a positive predictor of CAD and AMI in a mostly male South East Asian population.

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Section: Tablementioning

confidence: 59%

Lipoprotein(a) as predictor of coronary artery disease and myocardial infarction in a multi-ethnic Asian population

Loh

Chang

et al. 2022

Atherosclerosis

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“…The CV risk of elevated Lp(a) still remains an open question [ 19 ], in particular because of the unsettled definition of levels requiring treatment. Among the general population, Lp(a) concentrations have a more than 1000-fold interindividual range”, with a prevalence of 35% for values > 30 mg/dL, 20% for values > 60 mg/dL, 10% for values > 90 mg/dL, 5% for values > 116 mg/dL and 1% for values >180 mg/dL [ 20 ].…”

Section: Introduction—an Overviewmentioning

confidence: 99%

Lipoprotein(a) Lowering—From Lipoprotein Apheresis to Antisense Oligonucleotide Approach

Greco

Sirtori

Corsini

et al. 2020

JCM

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It is well-known that elevated lipoprotein(a)—Lp(a)—levels are associated with a higher risk of cardiovascular (CV) mortality and all-cause mortality, although a standard pharmacotherapeutic approach is still undefined for patients with high CV risk dependent on hyperlipoproteinemia(a). Combined with high Lp(a) levels, familial hypercholesterolemia (FH) leads to a greater CVD risk. In suspected FH patients, the proportion of cases explained by a rise of Lp(a) levels ranges between 5% and 20%. In the absence of a specific pharmacological approach able to lower Lp(a) to the extent required to achieve CV benefits, the most effective strategy today is lipoprotein apheresis (LA). Although limited, a clear effect on Lp(a) is exerted by PCSK9 antagonists, with apparently different mechanisms when given with statins (raised catabolism) or as monotherapy (reduced production). In the era of RNA-based therapies, a new dawn is represented by the use of antisense oligonucleotides APO(a)Lrx, able to reduce Lp(a) from 35% to over 80%, with generally modest injection site reactions. The improved knowledge of Lp(a) atherogenicity and possible prevention will be of benefit for patients with residual CV risk remaining after the most effective available lipid-lowering agents.

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“…Three recent studies have shown that patients who underwent PCI or coronary artery bypass grafting with high Lp(a) had a worse mortality (40)(41)(42). Conversely, another study of 1,245 patients with acute coronary syndrome stratified into four groups according to the quartile of Lp(a) showed that Lp(a) is not associated with long-term mortality (43). In our study, high Lp(a) (>19.1 mg/dL) was strongly related to the long-term prognosis in the total population and in subgroup analyses, and a Cox regression analysis further revealed that Lp(a) is an indicator of all-cause mortality even after adjusting for risk factors.…”

Section: Discussionmentioning

confidence: 99%

Associations of Lipoprotein(a) With Coronary Atherosclerotic Burden and All-Cause Mortality in Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

Xue

Shen

Zhou

et al. 2021

Front. Cardiovasc. Med.

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Background: The coronary atherosclerotic burden in patients with ST-segment elevation myocardial infarction (STEMI) has been identified as the main predictor of prognosis. However, the association of lipoprotein(a) [Lp(a)], a well-established proatherogenic factor, with atherosclerotic burden in patients with STEMI is unclear.Methods: In total, 1,359 patients who underwent percutaneous coronary intervention (PCI) for STEMI were included in analyses. Three prespecified models with adjustment for demographic parameters and risk factors were evaluated. Generalized additive models and restricted cubic spline analyses were used to assess the relationships of Lp(a) with Gensini scores and the no-reflow phenomenon. Kaplan–Meier curves were generated to explore the predictive value of Lp(a) for long-term all-cause mortality. Furthermore, mRNA expression levels of LPA in different groups were compared using the GEO database.Results: Patients in the highest tertile according to Lp(a) levels had an increased incidence of heart failure during hospitalization. Furthermore, patients with high levels of Lp(a) (>19.1 mg/dL) had sharply increased risks for a higher Gensini score (Pfor trend = 0.03) and no-reflow (Pfor trend = 0.002) after adjustment for demographic parameters and risk factors. During a median follow-up of 930 days, 132 deaths (9.95%) were registered. Patients with high levels of Lp(a) (>19.1 mg/dL) had the worst long-term prognosis (Pfor trend < 0.0001). In a subgroup analysis, patients with higher Lp(a) still had the highest all-cause mortality. Additionally, the mRNA expression levels of LPA in patients with STEMI with lower cardiac function were higher than those in other groups (P = 0.003). A higher coronary atherosclerotic burden was correlated with higher LPA expression (P = 0.01).Conclusion: This study provides the first evidence that Lp(a) (at both the protein and mRNA levels) is independently associated with coronary atherosclerotic lesions and prognosis in patients with STEMI treated with PCI.Clinical Trial Registration:http://www.chictr.org.cn/index.aspx, identifier: ChiCTR1900028516.

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Lipoprotein(a) plasma levels are not associated with survival after acute coronary syndromes: An observational cohort study

Cited by 17 publications

References 24 publications

Lipoprotein(a) as predictor of coronary artery disease and myocardial infarction in a multi-ethnic Asian population

Lipoprotein(a) as predictor of coronary artery disease and myocardial infarction in a multi-ethnic Asian population

Lipoprotein(a) Lowering—From Lipoprotein Apheresis to Antisense Oligonucleotide Approach

Associations of Lipoprotein(a) With Coronary Atherosclerotic Burden and All-Cause Mortality in Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

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