Impact of serum lipoprotein (a) level on coronary plaque progression and cardiovascular events in statin-treated patients with acute coronary syndrome: a yokohama-acs substudy

Abstract

Background: Lipoprotein (a) [Lp(a)] has been reported to be a residual risk factor in patients who have achieved target lipid levels. The aim of the present study was to investigate the associations of Lp(a) with plaque progression and major cardiovascular events in patients with acute coronary syndromes (ACS). Methods: The Yokohama-ACS study included 102 patients with ACS who underwent intravascular ultrasound (IVUS) at baseline and at 10-month follow-up after percutaneous coronary intervention (PCI). The patients were randomly assigned to receive either moderate-or low-intensity statin therapy. IVUS was performed to measure the plaque volume at non-culprit lesions. We enrolled 76 patients for whom Lp(a) levels at 10-month follow-up were available. Results: The patients were divided into 2 groups according whether their Lp(a) levels were 20 mg/dl [low Lp(a) group; n = 49] or >20 mg/dl [high Lp(a) group; n = 27]. Baseline characteristics and low-density lipoprotein cholesterol levels at 10-month follow-up were similar in the low Lp(a) group and high Lp(a) group (87 AE 29 mg/dl vs. 93 AE 27 mg/dl, p = 0.42). The low Lp(a) group had significant plaque regression, whereas the high Lp(a) group showed slight plaque progression (À6.8% vs. 2.5%, p = 0.02). Ninety-five percent of the prognostic data were obtained 5 years after PCI. The cumulative event-free survival rate was significantly lower in the high Lp(a) group (p = 0.02; log-rank test). Conclusions: Lp(a) levels may be an alternative predictor of further plaque regression and the likelihood of major adverse cardiovascular events in statin-treated ACS patients.

Elevated lipoprotein(a) levels as an independent predictor of long-term recurrent events in patients with acute coronary syndrome: an observational, retrospective cohort study

“…As for secondary prevention, the association between Lp(a) levels and the risk of subsequent CVEs has been recognized in the patients with established coronary artery diseases (CAD), even they were complicated with diabetes [6,7,19,23]. However, among studies that were targeted at subjects who had ever-experienced CVEs revealed inconsistent results [11–15,24]. As early as 2012, Zhou et al .…”

“…However, controversy still exists in people who had previous CVEs, especially ACS [11][12][13]. Aside from the negative results, among studies that reported poor prognosis, there is also evidence to suggest differential predictive values of Lp(a) in individual components of RCVEs [7,12,[14][15][16][17]. Therefore, we conducted this study to further discuss the effects of Lp(a) on predicting RCVEs and components of it in patients with ACS.…”

Pharmacokinetics, Pharmacodynamics, and Tolerability of Olpasiran in Healthy Japanese and Non-Japanese Participants: Results from a Phase I, Single-dose, Open-label Study

“…Although epidemiologic studies of Lp(a) level in Japanese patients are limited, there are no anticipated ethnicity-related differences in olpasiran efficacy based on reports of similar plasma Lp(a) concentrations and distributions between Japanese and white populations, 22 as well as similarities in the increased prevalence of major adverse cardiovascular events due to an elevated Lp(a) level in patients with ASCVD. [23][24][25] The results from this single-dose study may also be extrapolated to support the development of olpasiran in other East Asian populations, such as Chinese and Korean patients.…”

Elevated serum lipoprotein(a) is significantly associated with angiographic progression of coronary artery disease

“…Many previous studies have described the correlation between Lp(a) and coronary atherosclerosis progression using invasive imaging methods. In one study performed in 76 patients with acute coronary syndrome (ACS) who underwent intravascular ultrasound(IVUS) at baseline and at 10‐month follow‐up after percutaneous coronary intervention, the results showed that patients with serum levels of Lp(a) >20 mg/dl had slight plaque progression despite of statin therapy, suggesting Lp(a) levels could be an alternative predictor of further plaque progression 10 . Similarly, Hartmann et al reported that Lp(a) was positively related to plaque progression in the left main coronary artery by serial IVUS examinations 18 .…”

“…However, the correlation between Lp(a) and coronary atherosclerosis progression remains controversial. Previously, two study groups assessed the predictive utility of Lp(a) in coronary atherosclerosis progression by intravascular ultrasound, opposite results were obtained 9,10 . With the development of computed tomography technology, coronary computed tomography angiography (CTA) has been widely used for non‐invasive assessment of coronary atherosclerosis at outpatient department.…”