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Absence of High Lipoprotein(a) Levels Is an Independent Predictor of Acute Myocardial Infarction without Coronary
Andrea Kallmeyer1,2, Ana María Pello Lázaro1,2, Luis M Blanco-Colio3,4
1Department of Cardiology, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain.
Abstract:
The pathophysiological mechanisms underlying Myocardial Infarction with Non-Obstructive Coronary Artery Disease (MINOCA) are still under debate. Lipoprotein (a) [Lp(a)] has proinflammatory and prothrombotic actions and has been involved in the pathogenesis of atherosclerosis. However, no previous studies have linked Lp(a) levels with the probability of developing MINOCA. Moreover, the relationship between MINOCA and the plasma levels of other proatherogenic and proinflammatory molecules such as Interleukin-18 (IL18) and proprotein convertase subtilisin/kexin type 9 (PCSK9) has not been studied. We conducted a prospective, multicenter study involving 1042 patients with acute myocardial infarction (AMI). Seventy-six patients had no significant coronary lesions. All patients underwent plasma analysis on admission. MINOCA patients were younger (57 (47-68) vs. 61 (52-72) years; p = 0.010), more frequently female (44.7% vs. 21.0%; p < 0.001), and had lower rates of diabetes and of Lp(a) > 60 mg/dL (9.2% vs. 19.8%; p = 0.037) than those with coronary lesions; moreover, High Density Lipoprotein cholesterol (HDL-c) levels were higher in MINOCA patients. The absence of Lp(a) > 60 mg/dL and of diabetes were independent predictors of MINOCA, as well as female sex, high HDL-c levels, and younger age. IL-18 and PCSK9 levels were not predictors of MINOCA. During a follow-up of 5.23 (2.89, 7.37) years, the independent predictors of the primary outcome (acute ischemic events or death) in the whole sample were Lp(a) > 60 mg/dL, older age, low estimated Glomerular Filtration rate (eGFR), hypertension, previous heart failure (HF), coronary artery bypass graft, use of insulin, and no therapy with acetylsalicylic acid. In conclusion, in AMI patients, the absence of high Lp(a) levels, as well high HDL-c levels, were independent predictors of the inexistence of coronary artery disease. High Lp (a) levels were also an independent predictor of ischemic events or death.
Insights
Low Lipoprotein (a) [Lp(a)] levels and high High Density Lipoprotein cholesterol (HDL-c) predict Myocardial Infarction with Non-Obstructive Coronary Artery Disease (MINOCA). High Lp(a) also predicts future ischemic events or death.
Area of Science:
- Cardiology
- Biochemistry
- Pathophysiology
Background:
- Mechanisms of Myocardial Infarction with Non-Obstructive Coronary Artery Disease (MINOCA) remain unclear.
- Lipoprotein (a) [Lp(a)] is implicated in atherosclerosis due to its pro-inflammatory and pro-thrombotic properties.
- No prior studies have investigated the association between Lp(a) levels and MINOCA, or the role of Interleukin-18 (IL18) and PCSK9 in MINOCA.
Purpose of the Study:
- To investigate the relationship between plasma levels of Lp(a), IL18, and PCSK9 and the occurrence of MINOCA.
- To identify predictors of MINOCA among patients with acute myocardial infarction (AMI).
- To determine the long-term prognostic value of these biomarkers for adverse cardiovascular outcomes.
Main Methods:
- A prospective, multicenter study enrolled 1042 patients with AMI.
- Plasma levels of Lp(a), IL18, and PCSK9 were measured on admission.
- Patients were categorized into MINOCA (no significant coronary lesions) and non-MINOCA groups, with follow-up for ischemic events or death.
Main Results:
- MINOCA patients were younger, more frequently female, and had lower Lp(a) > 60 mg/dL and higher High Density Lipoprotein cholesterol (HDL-c) levels.
- Absence of Lp(a) > 60 mg/dL, absence of diabetes, female sex, high HDL-c, and younger age independently predicted MINOCA.
- IL-18 and PCSK9 levels were not predictors of MINOCA.
- High Lp(a) > 60 mg/dL, older age, low eGFR, hypertension, heart failure, and other factors predicted long-term adverse outcomes.
Conclusions:
- Absence of high Lp(a) and presence of high HDL-c are independent predictors of MINOCA in AMI patients.
- High Lp(a) levels are a significant independent predictor of future ischemic events and mortality.
- These findings highlight the role of Lp(a) in both the development of MINOCA and long-term prognosis.
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