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Cell-free Biochemical Fluorometric Enzymatic Assay for High-throughput Measurement of Lipid Peroxidation in High Density Lipoprotein
Published on: October 12, 2017
Moderately elevated lipoprotein (a) levels are associated with an earlier need for percutaneous coronary intervention
Athanasios Hoursalas1,2, Konstantinos Tsarouhas3, Christina Tsitsimpikou4
1Department of Pediatric Cardiology, Onasseio Cardiac Surgery Center, 17674 Athens, Greece.
Insights
High lipoprotein(a) levels increase cardiovascular disease (CVD) risk, particularly myocardial infarction. A threshold of 30 mg/dl for lipoprotein(a) indicates an earlier need for percutaneous coronary intervention (PCI) in CVD patients.
Area of Science:
- Cardiology
- Lipidology
- Preventive Medicine
Background:
- Cardiovascular disease (CVD) patients often remain at risk despite achieving lipid targets.
- Lipoprotein(a) [Lp(a)] is regaining interest as a prognostic marker in CVD.
- Current guidelines lack sufficient data to target Lp(a) for coronary artery disease (CAD) treatment.
Purpose of the Study:
- To investigate the association between Lp(a) levels and adverse cardiovascular (CV) events in dyslipidemic CVD patients over 10 years.
- To explore the relationship between Lp(a) and major CV risk factors.
- To identify a potential Lp(a) threshold for increased CV risk.
Main Methods:
- Retrospective study design.
- 10-year follow-up of cardiovascular disease patients with dyslipidemia.
- Analysis of lipoprotein(a) [Lp(a)] levels and cardiovascular events, including myocardial infarction and percutaneous coronary intervention (PCI).
- Kaplan-Meier survival analysis was used to compare event occurrence between Lp(a) groups.
Main Results:
- A statistically significant reduction in Lp(a) levels was observed during follow-up.
- Patients experiencing new myocardial infarction predominantly had Lp(a) levels >30 mg/dl (83.1±36.6 mg/dl).
- While initial PCI occurrence did not differ significantly between Lp(a) groups (≤30 vs. >30 mg/dl), patients with Lp(a) >30 mg/dl showed a significantly shorter time to a second or third PCI.
Conclusions:
- Elevated Lp(a) values are associated with a higher likelihood of myocardial infarction.
- An Lp(a) cut-off of 30 mg/dl is linked to an earlier need for percutaneous coronary intervention (PCI) in cardiovascular disease patients.
- This Lp(a) threshold is particularly relevant for patients requiring multiple revascularizations, highlighting its prognostic value.
Abstract:
A significant number of cardiovascular disease (CVD) patients, with the target lipid levels, as set by the guidelines, achieved, continue to remain at risk. In this setting, lipoprotein (Lp) a role in CVD prognosis is regaining interest. Although Lp(a) is related to the arteriosclerotic process, there is not currently an adequate amount of data for the inclusion of Lp(a) levels as a primary therapeutic target in the treatment of coronary artery disease (CAD) patients. In this framework, the current retrospective study aims to investigate the association of Lp(a) levels with the adverse cardiovascular (CV) events presented in a 10 year follow-up of CVD patients with dyslipidemia and its association with the major CV risk factors. A statistically significant reduction in Lp(a) levels was observed during the follow-up period (72.8±45.6 vs. 68.3±41.8 mg/dl; McNemar test; P<0.001). The vast majority of patients who suffered a new acute myocardial infarction during the follow up period had Lp(a) levels >30 mg/dl (24/28 patients, mean ± standard deviation Lp(a), 83.1±36.6 mg/dl, P=0.001). Kaplan-Meier survival analysis did not find statistically significant differences in a percutaneous coronary intervention (PCI) time occurrence during the follow-up period between patients with low (≤30 mg/dl) and high (>30 mg/dl) Lp(a) levels (log-rank P=0.305). On the other hand, when a second and third PCI conducted during the monitoring period were included in the Kaplan Meier analysis as events, the mean time for a PCI was significantly shorter (7.2%; P=0.01) for patients with Lp(a) levels >30 mg/dl. In conclusion, the current study reported that patients with high Lp(a) values are more prone to the occurrence of new myocardial infarction, while the Lp(a) cut-off value of 30 mg/dl was linked in CVD patients to an earlier need for PCI, especially in the most vulnerable group of patients with more than one (recurrent) revascularizations.
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