Predicting Cardiovascular Outcomes by Baseline Lipoprotein(a) Concentrations: A Large Cohort and Long‐Term Follow‐up Study on Real‐World Patients Receiving Percutaneous Coronary Intervention

Abstract

Background Although several studies have indicated that lipoprotein(a) is a useful prognostic predictor for patients following percutaneous coronary intervention ( PCI ), previous observations have somewhat been limited by either small sample size or short‐term follow‐up. Hence, this study aimed to evaluate the impact of lipoprotein(a) on long‐term outcomes in a large cohort of stable coronary artery disease patients after PCI . Methods and Results In this multicenter and prospective study, we consecutively enrolled 4078 stable coronary artery disease patients undergoing PCI from March 2011 to March 2016. They were categorized according to both the median of lipoprotein(a) levels and lipoprotein(a) values of <15 (low), 15 to 30 (medium), and ≥30 mg/ dL (high). All patients were followed up for occurrence of cardiovascular events, including cardiovascular death, nonfatal myocardial infarction, and stroke. During an average of 4.9 years of follow‐up, 315 (7.7%) cardiovascular events occurred. The events group had significantly higher lipoprotein(a) levels than the nonevents group. Compared with the low lipoprotein(a) group, Kaplan–Meier analysis showed that the high lipoprotein(a) group had a significantly lower cumulative event‐free survival rate, and multivariate Cox regression analysis further revealed that the high lipoprotein(a) group had significantly increased cardiovascular events risk. Moreover, adding continuous or categorical lipoprotein(a) to the Cox model led to a significant improvement in C‐statistic, net reclassification, and integrated discrimination. Conclusions With a large sample size and long‐term follow‐up, our data confirmed that high lipoprotein(a) levels could be associated with a poor prognosis after PCI in stable coronary artery disease patients, suggesting that lipoprotein(a) measurements may be useful for patient risk stratification before selective PCI .

Recent Updates of Lipoprotein(a) and Cardiovascular Disease

“…On the other hand, it showed that higher Lp(a) levels can be potential biomarkers for risk stratification and prognostic factors. Secondly, Liu et al 64 published a long-term prospective study of 4,078 patients. The study found that in patients with stable coronary heart disease after coronary intervention, plasma Lp(a) levels have a good predictive value for cardiovascular events, and that high Lp(a) levels (≥30 mg/dL) indicate a poor prognosis.…”

The Potential Role of Electronegative High-Density Lipoprotein H5 Subfraction in RA-Related Atherosclerosis

“…Hippe et al also revealed that elevated Lp(a) levels were an independent predictor of increased ASCVD burden in Caucasians [ 44 ]. A large-scale study in the Chinese population also showed that Lp(a) might be a biomarker for ASCVD [ 45 ]. In the present study, we revealed significantly higher Lp(a) levels in RA patients with high H5% compared to those with normal H5% and healthy subjects.…”

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

“…Moreover, new compounds like proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and antisense oligonucleotide (ASO) targeting hepatic apo(a) are recently reported to reduce circulating Lp(a) levels remarkably, suggesting that the need for a precise characterization of the Lp(a)-associated CV risk is of increasing importance [14][15][16] . To date, Lp(a) has been suggested as a risk predictor in some special populations, such as acute coronary syndrome, stable or premature coronary artery disease (CAD), diabetes mellitus (DM), familial hypercholesterolemia (FH) or postmenopausal women [17][18][19][20][21] . Whether Lp(a) poses additional risk in patients with prior MI is still unclear and the existing studies with small sample size or short-term follow-up did not achieve consistent evidence [22][23][24][25][26][27] .…”

“…[14][15][16] To date, Lp(a) has been suggested as a risk predictor in some special populations, such as patients with acute coronary syndrome, stable or premature coronary artery disease (CAD), diabetes mellitus (DM), familial hypercholesterolemia (FH), or postmenopausal women. [17][18][19][20][21] Whether Lp(a) poses additional risk in patients with prior MI is still unclear and the existing studies with a small sample size or short-term follow-up did not achieve consistent evidence. [22][23][24][25][26][27] Based on the situation that data regarding the prognostic importance of Lp(a) in post-MI patients are limited and new therapies are in development, 12 the present study aimed to evaluate the association between Lp(a) and long-term outcomes in patients with prior MI, which may help to provide additional information concerning the future clinical application of Lp(a).…”