Lipoprotein(a) As a Risk Factor for Recurrent Acute Myocardial Infarction and Mortality: Insights from Routine Clinical Practice

Overview

Journal Diagnostics (Basel)

Specialty Radiology

Date 2024 Dec 17

PMID 39682665

Authors

David Suran

Vojko Kanic

Peter Kokol

Tadej Zavrsnik

Florjan Verhnjak

Bojan Zlahtic

Andreja Sinkovic

Franjo Husam Naji

Affiliations

Soon will be listed here.

Abstract

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 ( = 0.921) for levels 51-90 mg/dL and 1.51 ( = 0.013) for levels > 90 mg/dL, compared with levels ≤ 50 mg/dL. The corresponding HRs for CV mortality were 1.13 ( = 0.300) and 1.14 ( = 0.348), and those for all-cause mortality were 1.09 ( = 0.310) and 1.20 ( = 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 ( = 0.013) for levels 51-90 mg/dL and 3.94 ( < 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.

References

Gurdasani D, Sjouke B, Tsimikas S, Hovingh G, Luben R, Wainwright N . Lipoprotein(a) and risk of coronary, cerebrovascular, and peripheral artery disease: the EPIC-Norfolk prospective population study. Arterioscler Thromb Vasc Biol. 2012; 32(12):3058-65. PMC: 4210842. DOI: 10.1161/ATVBAHA.112.255521. View

Kamstrup P, Tybjaerg-Hansen A, Nordestgaard B . Elevated lipoprotein(a) and risk of aortic valve stenosis in the general population. J Am Coll Cardiol. 2013; 63(5):470-7. DOI: 10.1016/j.jacc.2013.09.038. View

Wei D, Zhang X, Wang R, Zeng J, Zhang K, Yang J . Oxidized lipoprotein(a) increases endothelial cell monolayer permeability via ROS generation. Lipids. 2013; 48(6):579-86. DOI: 10.1007/s11745-013-3795-1. View

ODonoghue M, Morrow D, Tsimikas S, Sloan S, Ren A, Hoffman E . Lipoprotein(a) for risk assessment in patients with established coronary artery disease. J Am Coll Cardiol. 2013; 63(6):520-7. PMC: 3945105. DOI: 10.1016/j.jacc.2013.09.042. View

Erqou S, Kaptoge S, Perry P, Di Angelantonio E, Thompson A, White I . Lipoprotein(a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality. JAMA. 2009; 302(4):412-23. PMC: 3272390. DOI: 10.1001/jama.2009.1063. View

Pare G, Caku A, McQueen M, Anand S, Enas E, Clarke R . Lipoprotein(a) Levels and the Risk of Myocardial Infarction Among 7 Ethnic Groups. Circulation. 2019; 139(12):1472-1482. DOI: 10.1161/CIRCULATIONAHA.118.034311. View

Derby C, Crawford S, Pasternak R, Sowers M, Sternfeld B, Matthews K . Lipid changes during the menopause transition in relation to age and weight: the Study of Women's Health Across the Nation. Am J Epidemiol. 2009; 169(11):1352-61. PMC: 2727246. DOI: 10.1093/aje/kwp043. View

Sawabe M, Tanaka N, Mieno M, Ishikawa S, Kayaba K, Nakahara K . Low lipoprotein(a) concentration is associated with cancer and all-cause deaths: a population-based cohort study (the JMS cohort study). PLoS One. 2012; 7(4):e31954. PMC: 3317664. DOI: 10.1371/journal.pone.0031954. View

Galasso G, De Angelis E, Silverio A, Di Maio M, Cancro F, Esposito L . Predictors of Recurrent Ischemic Events in Patients With ST-Segment Elevation Myocardial Infarction. Am J Cardiol. 2021; 159:44-51. DOI: 10.1016/j.amjcard.2021.08.019. View

10.

Langsted A, Kamstrup P, Nordestgaard B . High Lipoprotein(a) and Low Risk of Major Bleeding in Brain and Airways in the General Population: a Mendelian Randomization Study. Clin Chem. 2017; 63(11):1714-1723. DOI: 10.1373/clinchem.2017.276931. View

11.

Reyes-Soffer G, Ginsberg H, Berglund L, Duell P, Heffron S, Kamstrup P . Lipoprotein(a): A Genetically Determined, Causal, and Prevalent Risk Factor for Atherosclerotic Cardiovascular Disease: A Scientific Statement From the American Heart Association. Arterioscler Thromb Vasc Biol. 2021; 42(1):e48-e60. PMC: 9989949. DOI: 10.1161/ATV.0000000000000147. View

12.

Kamstrup P, Benn M, Tybjaerg-Hansen A, Nordestgaard B . Extreme lipoprotein(a) levels and risk of myocardial infarction in the general population: the Copenhagen City Heart Study. Circulation. 2007; 117(2):176-84. DOI: 10.1161/CIRCULATIONAHA.107.715698. View

13.

Schwartz G, Ballantyne C, Barter P, Kallend D, Leiter L, Leitersdorf E . Association of Lipoprotein(a) With Risk of Recurrent Ischemic Events Following Acute Coronary Syndrome: Analysis of the dal-Outcomes Randomized Clinical Trial. JAMA Cardiol. 2017; 3(2):164-168. PMC: 5838593. DOI: 10.1001/jamacardio.2017.3833. View

14.

Kork F, Jankowski V, Just A, Pfeilschifter J, Tepel M, Zidek W . Oxidized low-density lipoprotein in postmenopausal women. J Hypertens. 2014; 32(7):1444-9. DOI: 10.1097/HJH.0000000000000197. View

15.

Ariyo A, Thach C, Tracy R . Lp(a) lipoprotein, vascular disease, and mortality in the elderly. N Engl J Med. 2003; 349(22):2108-15. DOI: 10.1056/NEJMoa001066. View

16.

Fogacci F, Cicero A, DAddato S, DAgostini L, Rosticci M, Giovannini M . Serum lipoprotein(a) level as long-term predictor of cardiovascular mortality in a large sample of subjects in primary cardiovascular prevention: data from the Brisighella Heart Study. Eur J Intern Med. 2016; 37:49-55. DOI: 10.1016/j.ejim.2016.08.018. View

17.

Hopewell J, Clarke R, Watkins H . Lp(a) (Lipoprotein[a]), an Exemplar for Precision Medicine: Insights From UK Biobank. Arterioscler Thromb Vasc Biol. 2020; 41(1):475-477. DOI: 10.1161/ATVBAHA.120.315549. View

18.

Langsted A, Nordestgaard B, Kamstrup P . Low lipoprotein(a) levels and risk of disease in a large, contemporary, general population study. Eur Heart J. 2021; 42(12):1147-1156. DOI: 10.1093/eurheartj/ehaa1085. View

19.

Feng Z, Li H, Bei W, Guo X, Wang K, Yi S . Association of lipoprotein(a) with long-term mortality following coronary angiography or percutaneous coronary intervention. Clin Cardiol. 2017; 40(9):674-678. PMC: 6490416. DOI: 10.1002/clc.22712. View

20.

Minana G, Gil-Cayuela C, Bodi V, de la Espriella R, Valero E, Mollar A . Lipoprotein(a) and long-term recurrent infarction after an episode of ST-segment elevation acute myocardial infarction. Coron Artery Dis. 2020; 31(4):378-384. DOI: 10.1097/MCA.0000000000000852. View