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. 2024 May 11;31(7):856-865.
doi: 10.1093/eurjpc/zwae007.

Impact of elevated lipoprotein(a) on coronary artery disease phenotype and severity

David M Leistner  1   2   3   4   5 , Andres Laguna-Fernandez  6 , Arash Haghikia  1   2   3   4 , Youssef S Abdelwahed  1   2   3 , Anne-Sophie Schatz  1   2   3 , Aslihan Erbay  1   2   3   5 , Robert Roehle  4   7 , Ana F Fonseca  6 , Philippe Ferber  6 , Ulf Landmesser  1   2   3   4
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Impact of elevated lipoprotein(a) on coronary artery disease phenotype and severity

David M Leistner et al. Eur J Prev Cardiol. .

Erratum in

Abstract

Aims: A thorough characterization of the relationship between elevated lipoprotein(a) [Lp(a)] and coronary artery disease (CAD) is lacking. This study aimed to quantitatively assess the association of increasing Lp(a) levels and CAD severity in a real-world population.

Methods and results: This non-interventional, cross-sectional, LipidCardio study included patients aged ≥21 years undergoing angiography (October 2016-March 2018) at a tertiary cardiology centre, who have at least one Lp(a) measurement. The association between Lp(a) and CAD severity was determined by synergy between PCI with taxus and cardiac surgery (SYNTAX)-I and Gensini scores and angiographic characteristics. Overall, 975 patients (mean age: 69.5 years) were included; 70.1% were male, 97.5% had Caucasian ancestry, and 33.2% had a family history of premature atherosclerotic cardiovascular disease. Median baseline Lp(a) level was 19.3 nmol/L. Patients were stratified by baseline Lp(a): 72.9% had < 65 nmol/L, 21.0% had ≥100 nmol/L, 17.2% had ≥125 nmol/L, and 12.9% had ≥150 nmol/L. Compared with the normal (Lp(a) < 65 nmol/L) group, elevated Lp(a) groups (e.g. ≥ 150 nmol/L) had a higher proportion of patients with prior CAD (48.4% vs. 62.7%; P < 0.01), prior coronary revascularization (39.1% vs. 51.6%; P = 0.01), prior coronary artery bypass graft (6.0% vs. 15.1%; P < 0.01), vessel(s) with lesions (68.5% vs. 81.3%; P = 0.03), diffusely narrowed vessels (10.9% vs. 16.5%; P = 0.01) or chronic total occlusion lesions (14.3% vs. 25.2%; P < 0.01), and higher median SYNTAX-I (3.0 vs. 5.5; P = 0.01) and Gensini (10.0 vs. 16.0; P < 0.01) scores.

Conclusion: Elevated Lp(a) was associated with a more severe presentation of CAD. Awareness of Lp(a) levels in patients with CAD may have implications in their clinical management.

Keywords: Atherosclerosis; Cardiovascular; Coronary artery disease; Lipoprotein(a).

Plain language summary

Patients with coronary artery disease (CAD) suffer with progressive plaque buildup in the walls of coronary blood vessels, which restricts blood flow and may result in serious cardiovascular outcomes such as chest pain (angina) and heart attacks (myocardial infarction). In this study, we assessed whether elevated levels of lipoprotein(a) [Lp(a)—a lipoprotein found in blood] are associated with more severe illness. We observed that elevated Lp(a) was associated with a higher proportion of patients with prior CAD, prior interventions on coronary blood vessels, and more diseased blood vessels. These collectively form what is considered a ‘severe’ clinical presentation of CAD, meaning a greater likelihood of adverse clinical outcomes.

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Conflict of interest statement

Conflict of interest: D.M.L. has received educational grant, honorarium, and travel grant for attending meetings from Novartis. A.H. has received honoraria for lectures from Novartis, NovoNordisk, and AstraZeneca, travel grant for attending meetings from Novartis, and advisory board fee from Novartis and NovoNordisk. Y.S.A., A.-S.S., A.E., and R.R. have no conflict of interest to declare. A.L.-F., A.F.F., and P.F. are employees and own stocks of Novartis Pharma AG, Basel. U.L. has received grant support from Novartis; consulting fees from Amgen, Novartis, Pfizer, and CRISPR Therapeutics; and honoraria from Amgen, AstraZeneca, Bayer, Boeringer Ingelheim, Daiichi Sankyo, Novartis, NovoNordisk, Pfizer, Sanofi, Amarin, and Berlin-Chemie.

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