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Elevated serum lipoprotein(a) is a risk factor for clinical recurrence after coronary balloon angioplasty
R L Desmarais1, I J Sarembock, C R Ayers
1Cardiovascular Division, University of Virginia School of Medicine, Charlottesville 22908.
Insights
Elevated lipoprotein (a) levels predict restenosis after coronary angioplasty. Higher Lp(a) concentrations correlate with increased risk of symptom recurrence and arterial narrowing post-procedure.
Area of Science:
- Cardiovascular Medicine
- Clinical Lipidology
Background:
- Elevated lipoprotein (a) [Lp(a)] is linked to coronary artery disease.
- Lp(a) interacts with lipid transport, coagulation, and fibrinolysis systems.
- These interactions may influence arterial healing post-angioplasty.
Purpose of the Study:
- To investigate the association between Lp(a) levels and restenosis after balloon angioplasty.
- To determine if Lp(a) predicts clinical recurrence post-procedure.
Main Methods:
- Assessed 240 patients undergoing coronary balloon angioplasty.
- Measured Lp(a) and other lipid profiles from fresh blood samples.
- Evaluated clinical recurrence and restenosis 4-6 months post-angioplasty via angiography or stress testing.
Main Results:
- 40% of patients experienced clinical recurrence.
- Patients with recurrence had significantly higher Lp(a) concentrations (median 29 vs 14, P < .0001).
- Lp(a) concentration was the sole predictor of recurrence in multivariate analysis (P < .0001).
Conclusions:
- Elevated Lp(a) is a significant risk factor for clinical recurrence after coronary angioplasty.
- Other lipid levels and clinical factors were not associated with recurrence.
- Prolonged serum storage led to decreased Lp(a) measurements.
Background:
Elevated lipoprotein (Lp) (a) concentrations are associated with coronary artery disease and myocardial infarction. Lp(a) is structurally related to proteins involved in lipid transport, fibrinolysis, coagulation, and cellular mitogenesis and is known to have important physiological interactions with the coagulation and fibrinolytic systems. Because these processes may be important to arterial healing after balloon injury, we hypothesized that elevated Lp(a) concentrations may be associated with recurrence of symptoms and restenosis after balloon angioplasty.
Methods And Results:
We assessed 240 consecutive patients undergoing coronary balloon angioplasty with measurements of Lp(a), total cholesterol, triglycerides, HDL cholesterol, LDL cholesterol, apolipoprotein A-I, and apolipoprotein B-100 concentrations from fresh specimens. Patients were evaluated 4 to 6 months after angioplasty for clinical recurrence by repeat angiography if angina had returned or by maximal exercise treadmill testing with thallium imaging if patients remained asymptomatic. Ninety-seven patients (40%) had clinical recurrence; 143 (60%) did not. Patients with recurrence had significantly greater Lp(a) concentrations compared with those without (median, 29 versus 14; P < .0001). Each patient quintile stratified by increasing Lp(a) concentrations had incrementally greater recurrence rates ranging from 27% (lowest quintile) to 60% (highest quintile). By multivariate logistic regression analysis, Lp(a) concentration was the only predictor of recurrence (P < .0001). A subset of frozen, stored serum samples showed a significant decrease in measured Lp(a) concentration over time (mean, 605 days; P < .01).
Conclusions:
An elevated Lp(a) concentration was a risk factor for clinical recurrence after percutaneous transluminal balloon coronary angioplasty. Other lipid levels or clinical characteristics were not significantly associated with recurrence. When serum was frozen and stored for a prolonged period, Lp(a) concentration decreased over time.