Prognostic value of elevated lipoprotein(a) in patients with acute coronary syndromes
Baris Gencer1, Fabio Rigamonti1, David Nanchen2
1Cardiology Division, Geneva University Hospitals, Geneva, Switzerland.
Insights
High lipoprotein(a) [Lp(a)] levels in acute coronary syndrome patients did not predict cardiovascular events. However, elevated Lp(a) may identify individuals unlikely to reach LDL-C targets post-ACS.
Area of Science:
- Cardiology
- Lipidology
- Preventive Cardiology
Background:
- Lipoprotein(a) [Lp(a)] is a risk factor for cardiovascular disease.
- Minimal Lp(a) target values are recommended for high-risk patients.
- The prognostic value of Lp(a) in acute coronary syndromes (ACS) requires further investigation.
Purpose of the Study:
- To assess the prognostic value of Lp(a) in patients hospitalized for ACS.
- To determine the association between elevated Lp(a) and major adverse cardiovascular events (MACE) at 1 year.
- To explore the relationship between Lp(a) levels and achievement of LDL-C targets.
Main Methods:
- Prospective cohort study of 1711 ACS patients.
- Lp(a) levels measured at angiography.
- Association with 1-year MACE (cardiac death, myocardial infarction, stroke) analyzed using Cox regression, adjusting for cardiovascular risk factors.
- Lp(a) assessed as elevated (≥30 mg/dL), tertiles, and continuous variable.
Main Results:
- Elevated Lp(a) (≥30 mg/dL) was observed in 23.0% of patients.
- Higher Lp(a) was associated with female gender and higher lipid levels.
- Elevated Lp(a) predicted failure to reach LDL-C target <1.8 mmol/L at 1 year (HR 1.71).
- No significant association was found between elevated Lp(a) and 1-year MACE.
Conclusions:
- In ACS patients, high Lp(a) levels at angiography do not predict 1-year cardiovascular outcomes if medically well-controlled.
- Elevated Lp(a) may serve as a marker for identifying patients at risk of not achieving LDL-C targets post-ACS.
- Real-world data suggest a nuanced role for Lp(a) in ACS risk stratification and treatment target adherence.
Background:
Minimal lipoprotein(a) [Lp(a)] target values are advocated for high-risk cardiovascular patients. We investigated the prognostic value of Lp(a) in the acute setting of patients with acute coronary syndromes (ACS).
Materials And Methods:
Plasma levels of Lp(a) were collected at time of angiography from 1711 patients hospitalized for ACS in a multicentre Swiss prospective cohort. Associations between elevated Lp(a) ≥30 mg/dL (cut-off corresponding to the 75th percentile of the assay) or Lp(a) tertiles at baseline, and major adverse cardiovascular events (MACE) at 1 year, defined as a composite of cardiac death, myocardial infarction or stroke, were assessed using hazard ratios (HR) and 95% confidence intervals (CI) adjusting for traditional cardiovascular risk factors (age, sex, smoking, diabetes, hypertension, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C] and triglycerides.
Results:
Lp(a) levels range between 2.5 and 132 mg/dL with a median value of 6 mg/dL and a mean value of 14.2 mg/dL. A total of 276 patients (23.0%) had Lp(a) plasma levels ≥30 mg/dL. Patients with elevated Lp(a) were more likely to be of female gender and to have higher levels of total cholesterol, LDL-C, HDL-C and triglycerides. Higher Lp(a) was associated with failure to reach the LDL-C target <1.8 mmol/L at 1 year (HR 1.71, 95% CI 1.13-2.58, P = 0.01). No association was found between elevated Lp(a) and MACE at 1 year (HR 1.05, 95% CI 0.64-1.73), nor for Lp(a) tertiles (HR 0.82, 95% CI 0.52-1.28, P > 0.20) or standardized continuous variables (0.98, 95% CI 0.82-1.19 for each increase of standard deviation).
Conclusions:
Our real-world data suggest high Lp(a) levels at time of angiography are not predictive for cardiovascular outcomes in patients otherwise medically well controlled, but might be useful to identify patients who would not be on LDL-C targets 1 year after ACS.
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