Impact of Lipoprotein (a) Levels on Long-Term Outcomes in Patients With Coronary Artery Disease and Left Ventricular
Jun Shitara1, Takatoshi Kasai1,2,3, Hirokazu Konishi4
1Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine.
Insights
High lipoprotein (a) levels are linked to worse long-term outcomes in patients with coronary artery disease and left ventricular systolic dysfunction. This finding highlights lipoprotein (a) as a significant risk factor for adverse cardiac events.
Area of Science:
- Cardiology
- Clinical Research
- Biomarkers
Background:
- Serum lipoprotein (a) [Lp(a)] is a potential risk factor in coronary artery disease (CAD).
- The impact of Lp(a) on long-term outcomes in patients with left ventricular (LV) systolic dysfunction and heart failure (HF) risk requires further investigation.
Purpose of the Study:
- To evaluate the prognostic significance of Lp(a) levels in patients diagnosed with both CAD and LV systolic dysfunction.
Main Methods:
- Analysis of 369 patients with LV systolic dysfunction (ejection fraction <50%) who underwent percutaneous coronary intervention.
- Patients were stratified into high Lp(a) (≥21.6 mg/dL) and low Lp(a) (<21.6 mg/dL) groups.
- Primary outcome: composite of all-cause death and readmission for acute coronary syndrome and/or HF over a median 5.1-year follow-up.
Main Results:
- Patients with high Lp(a) exhibited significantly worse cumulative event-free survival (P=0.005).
- High Lp(a) was identified as an independent predictor of adverse outcomes (HR, 1.54; 95% CI, 1.09-2.18; P=0.014) in multivariable analysis.
Conclusions:
- Elevated Lp(a) levels are associated with adverse long-term clinical outcomes in patients with CAD and LV systolic dysfunction.
Background:
Serum levels of lipoprotein (a) (Lp(a)) could be a risk factor for adverse events in patients with coronary artery disease (CAD). However, the effect of Lp(a) on long-term outcomes in patients with left ventricular (LV) systolic dysfunction, possibly through the increased likelihood for development of heart failure (HF), remains to be elucidated. This study aimed to determine the prognostic impact of Lp(a) in patients with CAD and LV systolic dysfunction.
Methods And Results:
A total of 3,508 patients who underwent percutaneous coronary intervention were candidates. We analyzed 369 patients with LV systolic dysfunction (defined as LV ejection fraction <50%). They were assigned to groups according to a median level of Lp(a) (i.e., high Lp(a), ≥21.6 mg/dL, n=185; low Lp(a), <21.6 mg/dL, n=184). The primary outcome was a composite of all-cause death and readmission for acute coronary syndrome and/or HF. The median follow-up period was 5.1 years. Cumulative event-free survival was significantly worse for the group with high Lp(a) than for the group with low Lp(a) (P=0.005). In the multivariable analysis, a high Lp(a) level was an independent predictor of the primary outcomes (hazard ratio, 1.54; 95% confidence interval, 1.09-2.18; P=0.014).
Conclusions:
A high Lp(a) value could be associated with long-term adverse clinical outcomes among patients with CAD and LV systolic dysfunction.
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