Association of Lipoprotein(a) With Risk of Recurrent Ischemic Events Following Acute Coronary Syndrome

Abstract

clinicaltrials.gov Identifier: NCT00658515.

Prognostic value of elevated lipoprotein(a) in patients with acute coronary syndromes

“…However, we did not find any significant correlation between the levels of Lp(a) , no association was found between Lp(a) concentrations and major adverse outcomes including 4139 patients treated with statins: for a doubling of the dose of Lp(a), the level of risk for CVD was stagnant (HR 1.01, 95% CI 0.96-1.06, P = 0.66). 17 Similar results were also reported in 3 different pooled studies with 6708 subjects known for coronary artery disease: the odds ratios (OR) were 1.03 (95% CI 0.96-1.11) for each increase in logtransformed standard deviation of Lp(a) or by quintile (highest vs lowest OR 1.05, 95% CI 0.83-1.34). 9 Some other data suggested that the risk associated with Lp(a) in patients with premature ACS was predominantly observed in those with concomitant elevated LDL-C levels, and not for patients with low LDL-C. 19 Recently, an individual patient-data meta-analysis of 29,069 patients from statin outcome trials suggested that baseline Lp(a) levels, as well as Lp(a) values on statin therapy, were both associated with CVD events, especially for values higher than 50 mg/dL after adjustment for confounding factors.…”

“…Recently, an individual patient‐data meta‐analysis of 29,069 patients from statin outcome trials suggested that baseline Lp(a) levels, as well as Lp(a) values on statin therapy, were both associated with CVD events, especially for values higher than 50 mg/dL after adjustment for confounding factors . Therefore, the association between Lp(a) and major adverse cardiovascular events in a population already treated with statin, especially after ACS, is not consistent across literature . Along these lines, the association of Lp(a) with LDL‐C is, however, well established and Lp(a) is also considered as a marker for the diagnosis of FH .…”

“…The cut‐off of 50 mg/dL for Lp(a) was neither protective nor a risk factor for disease progression . In a sub‐analysis of the Study of Dalcetrapib in Patients Hospitalized for an Acute Coronary Syndrome (dal‐OUTCOMES), no association was found between Lp(a) concentrations and major adverse outcomes including 4139 patients treated with statins: for a doubling of the dose of Lp(a), the level of risk for CVD was stagnant (HR 1.01, 95% CI 0.96‐1.06, P = 0.66) . Similar results were also reported in 3 different pooled studies with 6708 subjects known for coronary artery disease: the odds ratios (OR) were 1.03 (95% CI 0.96‐1.11) for each increase in log‐transformed standard deviation of Lp(a) or by quintile (highest vs lowest OR 1.05, 95% CI 0.83‐1.34) .…”

“…Using logistic regression model adjusted for previously tested confounding variables, we evaluated the odds ratios (OR) and the 95% confidence intervals (95% CI) of the association between Lp(a) values at time of the angiography and the achievement of LDL‐C targets 1 year after ACS. Continuous Lp(a) levels were categorized into tertiles to assess their association with clinical outcomes . We also classified patients into two groups, according to whether their Lp(a) levels were elevated (≥30 mg/dL) or normal (<30 mg/dL).…”

“…Continuous Lp(a) levels were categorized into tertiles to assess their association with clinical outcomes. 17 We also classified patients into two groups, according to whether their Lp(a) levels were elevated (≥30 mg/ dL) or normal (<30 mg/dL). The time-to-first event or composite events were analysed censoring patients at 365 days, death or last valid contact date.…”