Outcomes after coronary angiography in individuals with elevated lipoprotein(a)
Year: 2025
Type: article
Study design: Observational Study
Abstract: AIMS: Elevated lipoprotein(a) [Lp(a)] is an independent risk factor for coronary artery disease (CAD). Data on long-term outcomes following invasive coronary angiography (ICA) in those with elevated Lp(a) are limited. This study examined the association of Lp(a) levels with clinical outcomes after index ICA, accounting for baseline atherosclerotic plaque burden. METHODS AND RESULTS: Data were from participants with Lp(a) measurement who underwent index ICA between 2000 and 2023. Lp(a) levels were categorized as normal (<75 nmol/L), intermediate (75- < 125 nmol/L), high (125- < 175 nmol/L), and very high (≥175 nmol/L). Angiographic characteristics (severity, burden), CAD presentation (stable, acute), and subsequent clinical outcomes [acute myocardial infarction (AMI), revascularization, in-stent restenosis (ISR), and all-cause mortality] were assessed. Among 5118 participants, 973 (19.0%) had very high Lp(a). Compared with normal Lp(a), very high Lp(a) was associated with severe obstructive CAD {adjusted odds ratio (aOR), 1.51 [95% confidence interval (CI), 1.17-1.96]}, left main disease [aOR, 1.67 (95% CI, 1.22-2.29)], and a 14.04-point higher Gensini score (95% CI, 9.57-18.52). During a median (interquartile range) follow-up of 16.87 (6.38-18.99) years, participants with very high vs. normal Lp(a) had higher risk of AMI [adjusted hazard ratio (aHR), 1.20 (95% CI, 1.05-1.37)], revascularization [aHR, 1.32 (95% CI, 1.13-1.56)], ISR [aHR, 1.28 (95% CI, 1.04-1.56)], and mortality [aHR, 1.19 (95% CI, 1.05-1.34)]. Among 798 individuals undergoing coronary artery bypass grafting surgery after index ICA, those with very high vs. other Lp(a) were more likely to require subsequent percutaneous coronary intervention [aHR, 2.20 (95% CI, 1.06-4.58)]. CONCLUSION: Elevated Lp(a) levels are associated with increased burden of coronary atherosclerosis and significant residual risk for adverse outcomes following ICA, highlighting a need for targeted risk-reduction strategies.
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: G1289036858, G1449261147, Coronary plaque changes with statin and colchicine among people with high polygenic risk- a mechanistic pilot study, Health-related social needs and the risk of hypertension in young adult and early midlife women: The impact of pregnancy, Clonal hematopoiesis in humans: determinants of development and progression, Clonal Hematopoiesis and Cardiovascular Disease in Women with Premature Menopause, Genomics and Epigenetics of Atrial Fibrillation, G4405986302, G475755283, G5160451519, G6354290783, G6427414598, Machine Learning Artificial Intelligence Early Detection Stroke Atrial Fibrillation, Deep Learning to Identify Digital Biomarkers of Cardiovascular Disease, G9000166398, G9000175406, Whole genome sequences in ethnically diverse individuals to comprehensively characterize the genetic mechanisms of dyslipidemias, Enabling improved applicability and transferability of polygenic scores across populations, Integrating genomic and nongenomic risk for coronary artery disease, Clonal hematopoiesis as a mediator of cardiovascular disease in women with premature menopause, Clonal Hematopoiesis in the Women's Health Initiative
OpenAlex ID: W4416189917