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Lipoprotein(a) for risk assessment in patients with established coronary artery disease

Michelle L O'Donoghue1, David A Morrow1, Sotirios Tsimikas2

  • 1TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts.

Journal of the American College of Cardiology
|October 29, 2013
PubMed

Insights

Lipoprotein(a) [Lp(a)] is linked to cardiovascular event risk in coronary artery disease (CAD) patients, especially when low-density lipoprotein cholesterol is high. However, its prognostic value in patients with low cholesterol remains uncertain.

Area of Science:

  • Cardiology
  • Clinical Biochemistry
  • Preventive Medicine

Background:

  • Data on lipoprotein(a) [Lp(a)] and cardiovascular (CV) risk in secondary prevention populations are limited.
  • Assessing Lp(a)'s prognostic utility in established coronary artery disease (CAD) is crucial for risk stratification.

Purpose of the Study:

  • To evaluate the prognostic significance of lipoprotein(a) [Lp(a)] in individuals diagnosed with coronary artery disease (CAD).
  • To investigate the association between Lp(a) levels and cardiovascular event risk in secondary prevention settings.

Main Methods:

  • Combined data from 3 studies (6,708 subjects) with 8 prior studies, totaling 18,978 subjects with CAD.
  • Analyzed plasma Lp(a) levels and their correlation with cardiovascular events.
  • Stratified analyses based on low-density lipoprotein (LDL) cholesterol levels.

Main Results:

  • Increasing Lp(a) levels were not associated with CV events when analyzed continuously or by quintiles within the initial 3 studies.
  • Pooled analysis showed increased CV event risk in subjects with the highest Lp(a) levels (OR: 1.40), but with significant heterogeneity (p=0.001).
  • The association between Lp(a) and CV events was significant when average LDL cholesterol was ≥130 mg/dl (OR: 1.46), but not when <130 mg/dl (OR: 1.20).

Conclusions:

  • Lipoprotein(a) [Lp(a)] is significantly associated with cardiovascular event risk in patients with established coronary artery disease (CAD).
  • There is substantial heterogeneity in findings across studies regarding Lp(a)'s prognostic value.
  • The predictive role of Lp(a) in patients with low cholesterol levels requires further investigation.
Abstract

Keywords:
biomarkerslipoprotein(a)risk stratificationsecondary prevention

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