Related Experiment Video
Updated: Feb 7, 2026
Isolation and Analysis of Plasma Lipoproteins by Ultracentrifugation
Published on: January 28, 2021
Lipoprotein (a) levels and outcomes in stable outpatients with symptomatic artery disease
Juan F Sanchez Muñoz-Torrero1, Sergio Rico-Martín2, Lorenzo Ramón Álvarez3
1Department of Internal Medicine, Hospital Universitario San Pedro de Alcántara de Cáceres, Cáceres, Spain.
Insights
High lipoprotein (a) [Lp(a)] levels significantly increase the risk of heart attack, stroke, and limb amputation in patients with existing arterial disease. Even moderately elevated levels pose a substantial threat, underscoring Lp(a) as a critical prognostic marker.
Area of Science:
- Cardiovascular Medicine
- Genetics
- Epidemiology
Background:
- Genetic and epidemiological studies link high lipoprotein (a) [Lp(a)] levels to increased arterial disease risk.
- The prognostic value of Lp(a) in patients with established arterial disease requires further evaluation.
Purpose of the Study:
- To assess the prognostic value of baseline lipoprotein (a) [Lp(a)] levels.
- To evaluate the risk for myocardial infarction, ischemic stroke, or limb amputation in patients with established arterial disease based on Lp(a) levels.
Main Methods:
- Prospective registry (FRENA) of consecutive outpatients with coronary, cerebrovascular, or peripheral artery disease.
- Assessment of subsequent major adverse cardiovascular events in relation to baseline Lp(a) levels.
- Multivariable analysis to determine hazard ratios for cardiovascular events.
Main Results:
- 1503 stable outpatients were analyzed with mean follow-up of 36 months.
- Patients with Lp(a) 30-50 mg/dL showed significantly higher risk for myocardial infarction, ischemic stroke, and limb amputation (HRs ranging from 3.18 to 8.27).
- Patients with Lp(a) ≥50 mg/dL exhibited substantially increased risk (HRs ranging from 19.5 to 54.5) for these events.
Conclusions:
- Elevated Lp(a) levels (>30 mg/dL) are associated with a significantly higher risk of major adverse cardiovascular events in stable outpatients with symptomatic arterial disease.
- Lp(a) levels ≥50 mg/dL indicate an over 10-fold increased risk for myocardial infarction, ischemic stroke, or limb amputation.
Background And Aims:
Although genetic and epidemiological studies support that people with high lipoprotein (a) [Lp(a)] levels are at an increased risk for arterial disease, its prognostic value in patients with established artery disease has not been consistently evaluated.
Methods:
FRENA is a prospective registry of consecutive outpatients with coronary, cerebrovascular or peripheral artery disease. We assessed the risk for subsequent myocardial infarction, ischemic stroke or limb amputation according to Lp(a) levels at baseline.
Results:
As of December 2016, 1503 stable outpatients were recruited. Of these, 814 (54%) had levels <30 mg/dL, 319 (21%) had 30-50 mg/dL and 370 (25%) had ≥50 mg/dL. Over a mean follow-up of 36 months, 294 patients developed subsequent events (myocardial infarction 122, ischemic stroke 114, limb amputation 58) and 85 died. On multivariable analysis, patients with Lp(a) levels of 30-50 mg/dL were at a higher risk for myocardial infarction (hazard ratio [HR]: 4.67; 95%CI: 2.77-7.85), ischemic stroke (HR: 8.27; 95%CI: 4.14-16.5) or limb amputation (HR: 3.18; 95%CI: 1.36-7.44) than those with normal levels. Moreover, patients with levels ≥50 mg/dL were at increased risk for myocardial infarction (HR: 19.5; 95%CI: 10.5-36.1), ischemic stroke (HR: 54.5; 95%CI: 25.4-116.7) or limb amputation (HR: 22.7; 95%CI: 9.38-54.9).
Conclusions:
Stable outpatients with symptomatic artery disease and Lp(a) levels >30 mg/dL were at a 5-fold higher risk for subsequent myocardial infarction, stroke or limb amputation. Those with levels >50 mg/dL were at an over 10-fold higher risk.
Related Concept Videos
01:30Coronary Artery Disease I: Introduction
01:30Peripheral Artery Disease I: Introduction
01:26Coronary Artery Disease II: Pathophysiology
01:27Coronary Artery Disease V: Interprofessional Care
01:26Peripheral Artery Disease IV: Nursing Management
01:30Coronary Artery Disease III: Clinical Manifestations