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Prognostic impact of lipoprotein(a) in patients undergoing percutaneous coronary intervention modified by low density
Na Xu1, Deshan Yuan1, Yi Yao1
1National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Insights
Elevated lipoprotein(a) [Lp(a)] significantly increases long-term mortality risk in patients after percutaneous coronary intervention (PCI). This risk is particularly pronounced in individuals with higher low-density lipoprotein cholesterol (LDL-C) levels.
Area of Science:
- Cardiology
- Atherosclerosis Research
- Lipid Metabolism
Background:
- Lipoprotein(a) [Lp(a)] and low-density lipoprotein cholesterol (LDL-C) are established contributors to atherosclerosis.
- The prognostic significance of elevated Lp(a) in conjunction with varying LDL-C levels post-PCI requires further investigation.
Purpose of the Study:
- To evaluate the prevalence of increased Lp(a) across different LDL-C concentrations in patients who have undergone PCI.
- To determine the long-term prognostic implications of elevated Lp(a) on mortality outcomes in this patient cohort.
Main Methods:
- A cohort of 9,190 patients with coronary artery disease (CAD) post-PCI was analyzed.
- Patients were stratified into three groups based on baseline LDL-C (<70, 70-100, ≥100 mg/dL); increased Lp(a) was defined as >30 mg/dL.
- Cox regression, Kaplan-Meier, and sensitivity analyses were employed to assess outcomes (all-cause death, cardiac death).
Main Results:
- Increased Lp(a) prevalence rose with higher LDL-C levels (25.7% to 40.6%).
- Elevated Lp(a) was independently associated with increased 5-year all-cause and cardiac death risk, particularly in the LDL-C ≥100 mg/dL group (aHR 1.642 for all-cause death).
- These associations remained significant after multivariate adjustment and in sensitivity analyses.
Conclusions:
- Increased Lp(a) is linked to adverse long-term outcomes post-PCI, with risk modified by baseline LDL-C.
- Screening for high Lp(a) in patients with elevated LDL-C can aid in risk stratification for poor prognosis.
Background:
It is well established that lipoprotein(a)[Lp(a)] and low-density lipoprotein cholesterol (LDL-C) play a vital role in atherosclerosis. We investigated the prevalence and prognostic implications of increased Lp(a) in patients undergoing percutaneous coronary intervention (PCI) according to different LDL-C concentrations.
Methods:
A total of 9,190 patients with CAD after PCI were consecutively enrolled in the study and subsequently divided into three groups according to baseline LDL-C at cut-off of 70 and 100 mg/dl. Increased Lp(a) was defined as > 30 mg/dl. The primary endpoint was all-cause death. Second endpoint was cardiac death. Cox regression, Kaplan-Meier and Sensitivity analysis were performed.
Results:
During an average of 5.0 y of follow-up, 354 (3.9 %) patients experienced all-cause death with 213(2.3 %) of whom from cardiac death. Increased Lp(a) was present in 25.7 %, 34.2 %, and 40.6 % across the LDL-C < 70, 70-100 and≧100 mg/dl groups, respectively. After multivariate adjustment, Lp(a) elevation remained significantly associated with 5-y all-cause death (adjusted HR, 1.243; 95 % CI 1.001-1.544; p = 0.048) in the total cohort and only in those with LDL-C ≥ 100 mg/dl (adjusted HR, 1.642; 95 % CI 1.139-2.367; p = 0.008) when analyzed within each LDL-C category. Consistently with the results of associations between Lp(a) and cardiac death (adjusted HR, 1.534; 95 % CI 1.164-2.021; p = 0.002 for total cohort and adjusted HR, 2.404; 95 % CI 1.439-3.872; p < 0.001 for LDL-C ≥ 100 mg/dl). And this relationship holds after adjusting for LDL-Ccorr additionally. These findings are confirmed again in sensitivity analyses that excluded patients with Lp(a) concentrations in the top or the bottom 5 %.
Conclusions:
We confirmed that increased Lp(a) was associated with increased risk of long-term outcomes, and such an association was modified by the baseline LDL-C concentrations. Screening of high Lp(a) in individuals with elevations of LDL-C may enables risk stratification for poor prognosis.
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