The impact of lipoprotein (a) levels on long-term outcomes in patients with acute coronary syndrome and single-vessel coronary artery disease

Objective: to evaluate the impact of lipoprotein (a) [Lp(a)] levels on long-term outcomes in patients with acute coronary syndrome (ACS) and single-vessel coronary artery disease. Materials and methods: the study included 110 patients diagnosed with ACS and single-vessel coronary artery disease. Patients were divided into two groups based on Lp(a) levels: Lp(a) > 50 mg/dL (n=22) and Lp(a) < 50 mg/dL (n=88). Primary outcomes included survival and the frequency of recurrent cardiovascular events at 6, 12, and 36 months. Statistical analysis included t-test, chi-square test, Kaplan-Meier method, and Cox multivariate regression. Results: at 36 months, patients with high Lp(a) levels had significantly higher rates of recurrent myocardial infarctions (50% vs. 34.1%, p < 0.001) and all-cause mortality (59.1% vs. 23.9%, p < 0.001) compared to patients with normal Lp(a) levels. Conclusion: high Lp(a) levels are a significant prognostic factor for worse long-term outcomes in patients with ACS and single-vessel coronary artery disease. Measuring Lp(a) levels may improve management strategies for these patients.

1. Ross R. Atherosclerosis--an inflammatory disease. N Engl J Med. 1999;340(2):115-126. DOI: 10.1056/NEJM199901143400207

2. Libby P, Hansson GK. Inflammation and immunity in diseases of the arterial tree: players and layers. Circ Res. 2015;116(2):307-311. DOI: 10.1161/CIRCRESAHA.116.301313

3. Nordestgaard BG, Chapman MJ, Ray K, Borén J, Andreotti F, Watts GF, et al. Lipoprotein(a) as a cardiovascular risk factor: current status. Eur Heart J. 2010;31(23):2844-2853. DOI: 10.1093/eurheartj/ehq386

4. Caplice NM, Panetta C, Peterson TE, Kleppe LS, Mueske CS, Kostner GM, et al. Lipoprotein (a) binds and inactivates tissue factor pathway inhibitor: a novel link between lipoproteins and thrombosis. Blood. 2001;98(10):2980-2987. DOI: 10.1182/blood.v98.10.2980

5. Kronenberg F, Mora S, Stroes ESG, Ference BA, Arsenault BJ, Berglund L, et al. Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. Eur Heart J. 2022;43(39):3925-3946. DOI: 10.1093/eurheartj/ehac361

6. Tsimikas S. A Test in Context: Lipoprotein(a): Diagnosis, Prognosis, Controversies, and Emerging Therapies. J Am Coll Cardiol. 2017;69(6):692-711. DOI: 10.1016/j.jacc.2016.11.042

7. Emerging Risk Factors Collaboration; Erqou S, Kaptoge S, Perry PL, Di Angelantonio E, Thompson A, et al. Lipoprotein(a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality. JAMA. 2009;302(4):412-423. DOI: 10.1001/jama.2009.1063

8. Afanasyeva O.I., Ezhov M.V., Pokrovsky S.N. Analysis of the concentration of lipoprotein(a) in clinical practice: relevance and unsolved issues. The Journal of Atherosclerosis and Dyslipidemias. 2021;2(43):47–56. DOI: 10.34687/2219-8202.JAD.2021.02.0004.

9. Namitokov A.M., Zafiraki V.K., Kruchinova S.V., Ishevskaya O.P., Kosmacheva E.D. Practical significance of lipoproteid(a) measurement for risk stratification. The Journal of Atherosclerosis and Dyslipidemias. 2022;2(47):15-20. DOI: 10.34687/2219-8202.JAD.2022.02.0003

10. American College of Cardiology. An Update on Lipoprotein(a): The Latest on Testing, Treatment, and Guideline Recommendations. ACC; 2024.

11. Schwartz GG, Steg PG, Szarek M, Bittner VA, Diaz R, Goodman SG, et al. Peripheral Artery Disease and Venous Thromboembolic Events After Acute Coronary Syndrome: Role of Lipoprotein(a) and Modification by Alirocumab: Prespecified Analysis of the ODYSSEY OUTCOMES Randomized Clinical Trial. Circulation. 2020;141(20):1608-1617. DOI: 10.1161/CIRCULATIONAHA.120.046524

12. Wang G, Xia M, Liang C, Pu F, Liu S, Jia D. Prognostic value of elevated lipoprotein (a) in patients with acute coronary syndromes: a systematic review and meta-analysis. Front Cardiovasc Med. 2024;11:1362893. DOI: 10.3389/fcvm.2024.1362893

13. Miles LA, Fless GM, Levin EG, Scanu AM, Plow EF. A potential basis for the thrombotic risks associated with lipoprotein(a). Nature. 1989;339(6222):301-303. DOI: 10.1038/339301a0

14. Leibundgut G, Arai K, Orsoni A, Yin H, Scipione C, Miller ER, et al. Oxidized phospholipids are present on plasminogen, affect fibrinolysis, and increase following acute myocardial infarction. J Am Coll Cardiol. 2012;59(16):1426-1437. DOI: 10.1016/j.jacc.2011.12.033

15. Bittner VA, Szarek M, Aylward PE, Bhatt DL, Diaz R, Edelberg JM, et al. Effect of Alirocumab on Lipoprotein(a) and Cardiovascular Risk After Acute Coronary Syndrome. J Am Coll Cardiol. 2020;75(2):133-144. DOI: 10.1016/j.jacc.2019.10.057

16. Ray KK, Wright RS, Kallend D, Koenig W, Leiter LA, Raal FJ, et al. Two Phase 3 Trials of Inclisiran in Patients with Elevated LDL Cholesterol. N Engl J Med. 2020;382(16):1507-1519. DOI: 10.1056/NEJMoa1912387

17. Raal FJ, Kallend D, Ray KK, Turner T, Koenig W, Wright RS, et al. Inclisiran for the Treatment of Heterozygous Familial Hypercholesterolemia. N Engl J Med. 2020;382(16):1520-1530. DOI: 10.1056/NEJMoa1913805

18. Heigl F, Pflederer T, Klingel R, Hettich R, Lotz N, Reeg H, et al. Lipoprotein apheresis in Germany - Still more commonly indicated than implemented. How can patients in need access therapy? Atheroscler Suppl. 2019;40:23-29. DOI: 10.1016/j.atherosclerosissup.2019.08.038