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Thromb Haemost 2021; 121(09): 1161-1168
DOI: 10.1055/a-1340-2109
Coagulation and Fibrinolysis

Lipoprotein(a) and Cardiovascular Outcomes in Patients with Previous Myocardial Infarction: A Prospective Cohort Study

Ye-Xuan Cao
1   State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
2   Department of Cardiology, Beijing Chaoyang Hospital Affiliated to Capital University of Medical Science, Beijing, China
,
Hui-Wen Zhang
1   State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
,
Jing-Lu Jin
1   State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
,
Hui-Hui Liu
1   State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
,
Yan Zhang
1   State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
,
Meng Zhang
1   State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
,
Ying Gao
1   State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
,
Yuan-Lin Guo
1   State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
,
Na-Qiong Wu
1   State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
,
Cheng-Gang Zhu
1   State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
,
Qian Dong
1   State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
,
Jing Sun
1   State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
,
Le-Feng Wang
2   Department of Cardiology, Beijing Chaoyang Hospital Affiliated to Capital University of Medical Science, Beijing, China
,
Run-Lin Gao
1   State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
,
Jian-Jun Li 
1   State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
› Author Affiliations Funding This work was supported by the Capital Health Development Fund (201614035), CAMS Major Collaborative Innovation Project (2016-I2M-1–011), and the National Key R&D Program of China (2016YFC1301102).
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Abstract

Lipoprotein(a) [Lp(a)] has been documented to be associated with atherothrombotic diseases. However, the prognostic impact of Lp(a) on long-term clinical outcomes among patients with previous myocardial infarction (MI) remains unclear. In this prospective cohort study, we consecutively enrolled 3,864 post-MI patients to assess the cardiovascular events (CVEs), including MI, ischemic stroke, and cardiac mortality. Lp(a) levels were determined using an immunoturbidimetry assay and the participants were categorized according to Lp(a) quartiles. The Cox proportional hazards model was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). During a median follow-up of 4.1 years, 331 (8.6%) CVEs were identified. Lp(a) was significantly higher in patients with CVEs (25.17 [11.13–47.83] vs. 18.18 [7.90–40.30] mg/dL, p = 0.001). The cumulative rates of CVEs and cardiac mortality were significantly higher in patients with high Lp(a) levels (both log-rank p < 0.001). Multivariate Cox regression analysis showed a significant correlation between Lp (a) levels treated as a natural logarithm-transformed continuous variable and increased CVEs (adjusted HR:1.22, 95% CI:1.09–1.35, p = 0.001) or cardiac mortality (HR:1.30, 95% CI:1.14–1.48, p < 0.001). The addition of Lp(a) to a prognostic model revealed a significant improvement in C-statistic, net reclassification, and integrated discrimination. In conclusion, elevated levels of Lp(a) were indeed associated with long-term worse outcomes in patients with prior MI, suggesting a novel hint that the measurement of Lp(a) might help in risk stratification and future management in those high-risk individuals.

Keywords

Lipoprotein(a) - myocardial infarction - cardiovascular events - cardiac mortality

Authors’ Contributions

Conception/design: J.-J.L; provision of study materials: Y.G., Y.-L.G., N.-Q.W.; collection and/or assembly of data: Y.-X.C., C.-G.Z., Q.D., J.S.; data analysis and interpretation: Y.-X.C., H.-W.Z.; J.-J.L., H.-H.L.; manuscript writing: Y.-X.C.; manuscript revising: L.-F.W., R.-L.G., J.-J.L; approval of manuscript: all authors.


Supplementary Material



Publication History

Received: 14 October 2020

Accepted: 15 December 2020

Accepted Manuscript online:
18 December 2020

Article published online:
13 February 2021

© 2020. Thieme. All rights reserved.

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Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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