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Lipoprotein(a) as a risk predictor for cardiac mortality in patients with acute coronary syndromes

P Stubbs1, M Seed, D Lane

  • 1Royal Free Hospital, London, UK.

European Heart Journal
|October 29, 1998
PubMed

Insights

Elevated lipoprotein(a) levels in acute coronary syndrome patients predict cardiac death. A concentration of >= 30 mg/dL indicates higher risk in myocardial infarction, while >= 7.9 mg/dL is significant for unstable angina.

Area of Science:

  • Cardiology
  • Atherosclerosis Research
  • Clinical Risk Stratification

Background:

  • Elevated lipoprotein(a) [Lp(a)] is a recognized risk factor for atherothrombotic diseases.
  • The prognostic value of baseline Lp(a) in acute coronary syndromes (ACS) requires further elucidation.

Purpose of the Study:

  • To investigate whether baseline Lp(a) concentrations predict adverse outcomes in patients hospitalized with ACS.
  • To determine specific Lp(a) thresholds for risk stratification in myocardial infarction (MI) and unstable angina (UA) patients.

Main Methods:

  • Prospective study of 519 patients admitted with suspected ACS.
  • Assessment of baseline Lp(a) concentrations and their association with cardiac death over a median 3-year follow-up.
  • Utilized univariate and multivariate regression models for prognostic significance analysis.

Main Results:

  • In MI patients (n=266), baseline Lp(a) >= 30 mg/dL was linked to a 62% increase in cardiac death (29.8% vs 18.6%, P=0.04).
  • A baseline Lp(a) >= 30 mg/dL remained an independent predictor of cardiac death in MI patients (P=0.037).
  • In UA patients (n=197), baseline Lp(a) >= 7.9 mg/dL predicted cardiac death in both univariate (P=0.021) and multivariate (P=0.035) analyses.

Conclusions:

  • Baseline Lp(a) concentrations are associated with increased cardiac death risk in ACS patients.
  • An Lp(a) threshold of >= 30 mg/dL is a relevant risk discriminator for MI.
  • Lower Lp(a) concentrations (>= 7.9 mg/dL) are prognostically significant in patients admitted with unstable angina.
Abstract

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