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Multicenter Study
. 2020 Mar 17;9(6):e015355.
doi: 10.1161/JAHA.119.015355. Epub 2020 Mar 14.

Association of Serum Lipoprotein (a) With the Requirement for a Peripheral Artery Operation and the Incidence of Major Adverse Cardiovascular Events in People With Peripheral Artery Disease

Jonathan Golledge  1   2   3 , Sophie Rowbotham  1   4 , Ramesh Velu  2 , Frank Quigley  5 , Jason Jenkins  6 , Michael Bourke  7 , Bernie Bourke  7 , Shivshankar Thanigaimani  1 , Dick C Chan  8 , Gerald F Watts  8   9
Affiliations
Multicenter Study

Association of Serum Lipoprotein (a) With the Requirement for a Peripheral Artery Operation and the Incidence of Major Adverse Cardiovascular Events in People With Peripheral Artery Disease

Jonathan Golledge et al. J Am Heart Assoc. .

Abstract

Background The aim of this study was to assess the relationship between serum lipoprotein (a) (Lp[a]) concentration and the requirement for peripheral artery disease (PAD) operations or incidence of major adverse cardiovascular events. Methods and Results A total of 1472 people with PAD presenting with intermittent claudication (n=355), abdominal aortic aneurysm (n=989) or critical limb ischemia (n=128) were prospectively recruited from 4 outpatient clinics in Australia. Lp(a) was measured in serum samples collected at recruitment using an immunoassay. Participants were followed for a median (interquartile range) of 2.4 (0.1-6.1) years to record requirement for any PAD operation, defined to include any open or endovascular PAD intervention (lower limb peripheral revascularization, abdominal aortic aneurysm repair, other aneurysm repair, or carotid artery revascularization). Myocardial infarctions, strokes, and deaths were also recorded. The association of Lp(a) with events was assessed using Cox proportional hazard analysis adjusting for traditional risk factors. Participants with Lp(a) ≥30 mg/dL had a greater requirement for any PAD operation (hazard ratio, 1.20, 95% CI, 1.02-1.41) and lower limb peripheral revascularization alone (hazard ratio 1.33, 95% CI, 1.06-1.66) but no increased risk of major adverse cardiovascular events or all-cause mortality. Lp(a) ≥50 mg/dL and a 40 mg/dL increase in Lp(a) were also associated with an increased risk of lower limb peripheral revascularization alone but not with other outcomes. Conclusions In participants with PAD referred for hospital management those with high Lp(a) had greater requirement for lower limb peripheral revascularization but Lp(a) was not consistently associated with other clinical events.

Keywords: Peripheral artery disease; lipoprotein (a); surgical treatment.

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Figures

Figure 1
Figure 1
Freedom from requirement for any peripheral artery disease operation in people referred for management of peripheral artery disease in relation to serum lipoprotein (a) ≥30 mg/dL. PAD indicates peripheral artery disease.
Figure 2
Figure 2
Freedom from requirement for lower limb peripheral revascularization in people referred for management of peripheral artery disease in relationship to serum lipoprotein (a) ≥30 mg/dL.
Figure 3
Figure 3
Freedom from requirement for abdominal aortic aneurysm repair in people referred for management of peripheral artery disease in relationship to serum lipoprotein (a) ≥30 mg/d. AAA indicates abdominal aortic aneurysm.
Figure 4
Figure 4
Freedom from major adverse cardiovascular events in people referred for management of peripheral artery disease in relationship to serum lipoprotein (a) ≥30 mg/dL. MACE indicates major cardiovascular event (ie, myocardial infarction, stroke, or cardiovascular death).
Figure 5
Figure 5
Survival in people referred for management of peripheral artery disease in relationship to serum lipoprotein (a) ≥30 mg/dL.
See this image and copyright information in PMC

References

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