Are Elevated Lipoprotein (a) Levels Associated with Increased Adverse Events After Peripheral Endovascular Treatment?

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.

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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.

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.