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Lipoprotein(a) as a Risk Factor for Recurrent Acute Myocardial Infarction and Mortality: Insights from Routine
David Šuran1,2, Vojko Kanič1,2, Peter Kokol2,3
1Clinical Department of Cardiology and Angiology, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia.
Insights
Elevated Lipoprotein(a) [Lp(a)] levels increase recurrent heart attack risk in women over 65. This study found no significant link between Lp(a) and mortality in acute myocardial infarction patients.
Area of Science:
- Cardiology
- Biochemistry
- Epidemiology
Background:
- Lipoprotein(a) [Lp(a)] is a known risk factor for atherosclerotic cardiovascular disease.
- Limited evidence exists on Lp(a)'s association with recurrent cardiovascular events after an initial event.
Purpose of the Study:
- To investigate the association between Lp(a) levels and recurrent acute myocardial infarction (AMI), cardiovascular mortality, and all-cause mortality in patients hospitalized for AMI.
- To explore potential sex and age-specific differences in these associations.
Main Methods:
- Retrospective analysis of routine clinical data from 2248 patients hospitalized for AMI between 2000 and 2022.
- Patients stratified into three Lp(a) level groups: ≤50 mg/dL, 51-90 mg/dL, and >90 mg/dL.
- Multivariable-adjusted Cox regression analysis to assess outcomes.
Main Results:
- Elevated Lp(a) (>90 mg/dL) was associated with a 1.51-fold increased risk of recurrent AMI (p=0.013) compared to levels ≤50 mg/dL.
- No significant associations were found between Lp(a) levels and cardiovascular or all-cause mortality.
- A significant association between Lp(a) and recurrent AMI was observed only in women aged >65 years, with adjusted HRs of 2.34 (51-90 mg/dL) and 3.94 (>90 mg/dL).
Conclusions:
- Lipoprotein(a) is associated with a significantly higher risk of recurrent AMI specifically in women over 65 years with Lp(a) levels >50 mg/dL.
- No significant associations were found between Lp(a) and cardiovascular or all-cause mortality in the overall study population.
Background:
Lipoprotein(a) [Lp(a)] is a well-established risk factor for incident atherosclerotic cardiovascular (CV) disease. However, evidence regarding its association with recurrent events is limited. To address this gap, we conducted a retrospective analysis of routine clinical data, focusing on patients hospitalized for acute myocardial infarction (AMI) between 2000 and 2022 with available admission Lp(a) results.
Methods:
Patients were stratified into three groups based on their Lp(a) level (≤50 mg/dL, 51-90 mg/dL, and >90 mg/dL). A multivariable-adjusted Cox regression analysis was performed to assess the associations of Lp(a) with recurrent AMI, CV mortality, and all-cause mortality.
Results:
A total of 2248 patients (31.5% women), with a mean age of 64.7 ± 12.2 years, were retrospectively followed until 31 December 2022, or death. The multivariable-adjusted hazard ratios (HRs) for recurrent AMI were 1.01 (p = 0.921) for levels 51-90 mg/dL and 1.51 (p = 0.013) for levels > 90 mg/dL, compared with levels ≤ 50 mg/dL. The corresponding HRs for CV mortality were 1.13 (p = 0.300) and 1.14 (p = 0.348), and those for all-cause mortality were 1.09 (p = 0.310) and 1.20 (p = 0.090), respectively. Stratification by sex and age revealed a significant association of Lp(a) with recurrent AMI only in women aged > 65 years, with adjusted HRs of 2.34 (p = 0.013) for levels 51-90 mg/dL and 3.94 (p < 0.001) for levels > 90 mg/dL, compared with levels ≤ 50 mg/dL.
Conclusions:
In the presented study, Lp(a) was associated with a significantly higher risk of recurrent AMI only in women aged > 65 years with Lp(a) levels > 50 mg/dL. We found no significant associations between Lp(a) and CV or all-cause mortality.
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