Moderately elevated lipoprotein (a) levels are associated with an earlier need for percutaneous coronary intervention in recurrent cardiovascular disease

Athanasios Hoursalas; Konstantinos Tsarouhas; Christina Tsitsimpikou; Genovefa Kolovou; Alexander Vardavas; Ioannis Hoursalas; Demetrios A Spandidos; Haralampos Milionis; Moses Elisaf; Stavroula Tsiara

doi:10.3892/etm.2022.11371

Moderately elevated lipoprotein (a) levels are associated with an earlier need for percutaneous coronary intervention in recurrent cardiovascular disease

Exp Ther Med. 2022 May 13;24(1):444. doi: 10.3892/etm.2022.11371. eCollection 2022 Jul.

Affiliations

¹ Department of Pediatric Cardiology, Onasseio Cardiac Surgery Center, 17674 Athens, Greece.
² Department of Internal Medicine, Faculty of Medicine, University Hospital of Ioannina, 45110 Ioannina, Greece.
³ Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece.
⁴ General Chemical State Laboratory of Greece, 11521 Athens, Greece.
⁵ Preventive Cardiology and Lipoprotein Apheresis Unit, Metropolitan Hospital, 18547 Piraeus, Greece.
⁶ Laboratory of Toxicology and Forensic Sciences, Faculty of Medicine, University of Crete, 71500 Heraklion, Greece.
⁷ YGEIA Diagnostics, Private Practitioner, 20131 Korinthos, Greece.
⁸ Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece.

Abstract

A significant number of cardiovascular disease (CVD) patients, with the target lipid levels, as set by the guidelines, achieved, continue to remain at risk. In this setting, lipoprotein (Lp) a role in CVD prognosis is regaining interest. Although Lp(a) is related to the arteriosclerotic process, there is not currently an adequate amount of data for the inclusion of Lp(a) levels as a primary therapeutic target in the treatment of coronary artery disease (CAD) patients. In this framework, the current retrospective study aims to investigate the association of Lp(a) levels with the adverse cardiovascular (CV) events presented in a 10 year follow-up of CVD patients with dyslipidemia and its association with the major CV risk factors. A statistically significant reduction in Lp(a) levels was observed during the follow-up period (72.8±45.6 vs. 68.3±41.8 mg/dl; McNemar test; P<0.001). The vast majority of patients who suffered a new acute myocardial infarction during the follow up period had Lp(a) levels >30 mg/dl (24/28 patients, mean ± standard deviation Lp(a), 83.1±36.6 mg/dl, P=0.001). Kaplan-Meier survival analysis did not find statistically significant differences in a percutaneous coronary intervention (PCI) time occurrence during the follow-up period between patients with low (≤30 mg/dl) and high (>30 mg/dl) Lp(a) levels (log-rank P=0.305). On the other hand, when a second and third PCI conducted during the monitoring period were included in the Kaplan Meier analysis as events, the mean time for a PCI was significantly shorter (7.2%; P=0.01) for patients with Lp(a) levels >30 mg/dl. In conclusion, the current study reported that patients with high Lp(a) values are more prone to the occurrence of new myocardial infarction, while the Lp(a) cut-off value of 30 mg/dl was linked in CVD patients to an earlier need for PCI, especially in the most vulnerable group of patients with more than one (recurrent) revascularizations.

Keywords: coronary artery disease; dyslipidemia; lipoprotein a; percutaneous coronary intervention.

Grants and funding

Funding: No funding was received.