Peripheral arterial disease is a manifestation of systemic atherosclerotic disease with increasing prevalence. Moreover, this disease is associated with a high risk of mortality and cardiovascular events.
Lipoprotein (a) (Lp a)—which has a proatherogenic, proinflammatory, and antifibrinolytic role—has been shown to be related to major cardiovascular events and peripheral vascular events after acute coronary syndromes (ACS). However, the role of Lp a in clinical outcomes after peripheral endovascular treatment is currently uncertain.
The aim of this prospective observational study was to examine the prognostic impact of Lp a values in patients with peripheral vascular disease who underwent percutaneous intervention.
The primary endpoint (PEP) was major adverse cardiovascular events (MACE) defined as all-cause mortality, stroke, and acute myocardial infarction (AMI). The secondary endpoint (SEP) was major adverse lower limb-related events (MALE), defined as major amputation or reintervention.
The study enrolled 1169 patients. Of them, 369 patients had elevated Lp a (>30 mg/dL) levels, and 800 patients had low Lp a (≤30 mg/dL) levels. Mean patient age was 74 years old, and most subjects were male. Compared with the low Lp a group, the high Lp a group had a lower proportion of men, lower body mass index, a higher proportion of heart failure, chronic lower limb ischemia, multi-vessel lesions, and high LDL levels. There were no differences in statin administration.
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The 5-year cumulative incidence of MACE was significantly higher in patients with high Lp a (48.1% vs. 27.3%; p < 0.001), and the 5-year cumulative incidence of MALE was significantly higher in the same patient group (67.9% vs. 27.2%; p < 0.001). According to the multivariate analysis, patients with elevated Lp a had independently higher incidence of MACE and MALE (adjusted hazard ratio [HR]: 1.93 [95% confidence interval (CI): 1.44-2.59] and 4.15 [95% CI: 3.14-5.50] respectively with p < 0.001.)
Conclusion
Elevated Lp a levels were an independent factor associated with increased major cardiovascular events and lower limb-associated events after endovascular revascularization in patients with peripheral vascular disease, independent of LDL cholesterol levels and statin administration.
Dr. Andrés Rodríguez.
Member of the Editorial Board of SOLACI.org.
Original Title: Impact of High Lipoprotein(a) Levels on Clinical Outcomes Following Peripheral Endovascular Therapy.
Reference: Yusuke Tomoi, MD et al J Am Coll Cardiol Intv 2022;15:1466–1476.
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