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Pavlyha M, Hunter M, Nowygrod R, Patel V, Morrissey N, Bajakian D, Li Y, Reyes-Soffer G. Small apolipoprotein(a) isoforms may predict primary patency following peripheral arterial revascularization. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.18.24304485. [PMID: 38562737 PMCID: PMC10984047 DOI: 10.1101/2024.03.18.24304485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background High lipoprotein (a) [Lp(a)] is associated with adverse limb events in patients undergoing lower extremity revascularization. Lp(a) levels are genetically pre-determined, with LPA gene encoding for two apolipoprotein (a) [apo(a)] isoforms. Isoform size variations are driven by the number of kringle IV type 2 (KIV-2) repeats. Lp(a) levels are inversely correlated with isoform size. In this study, we examined the role of Lp(a) levels, apo(a) size and inflammatory markers with lower extremity revascularization outcomes. Methods 25 subjects with chronic peripheral arterial disease (PAD), underwent open or endovascular lower extremity revascularization (mean age of 66.7±9.7 years; F=12, M=13; Black=8, Hispanic=5, and White=12). Pre- and post-operative medical history, self-reported symptoms, ankle brachial indices (ABIs), and lower extremity duplex ultrasounds were obtained. Plasma Lp(a), apoB100, lipid panel, and pro-inflammatory markers (IL-6, IL-18, hs-CRP, TNFα) were assayed preoperatively. Isoform size was estimated using gel electrophoresis and weighted isoform size ( wIS ) calculated based on % isoform expression. Firth logistic regression was used to examine the relationship between Lp(a) levels, and wIS with procedural outcomes: symptoms (better/worse), primary patency at 2-4 weeks, ABIs, and re-intervention within 3-6 months. We controlled for age, sex, history of diabetes, smoking, statin, antiplatelet and anticoagulation use. Results Median plasma Lp(a) level was 108 (44, 301) nmol/L. The mean apoB100 level was 168.0 ± 65.8 mg/dL. These values were not statistically different among races. We found no association between Lp(a) levels and w IS with measured plasma pro-inflammatory markers. However, smaller apo(a) wIS was associated with occlusion of the treated lesion(s) in the postoperative period [OR=1.97 (95% CI 1.01 - 3.86, p<0.05)]. The relationship of smaller apo(a) wIS with re-intervention was not as strong [OR=1.57 (95% CI 0.96 - 2.56), p=0.07]. We observed no association between wIS with patient reported symptoms or change in ABIs. Conclusions In this small study, subjects with smaller apo(a) isoform size undergoing peripheral arterial revascularization were more likely to experience occlusion in the perioperative period and/or require re-intervention. Larger cohort studies identifying the mechanism and validating these preliminary data are needed to improve understanding of long-term peripheral vascular outcomes. Key Findings 25 subjects with symptomatic PAD underwent open or endovascular lower extremity revascularization in a small cohort. Smaller apo(a) isoforms were associated with occlusion of the treated lesion(s) within 2-4 weeks [OR=1.97 (95% CI 1.01 - 3.86, p<0.05)], suggesting apo(a) isoform size as a predictor of primary patency in the early period after lower extremity intervention. Take Home Message Subjects with high Lp(a) levels, generally have smaller apo(a) isoform sizes. We find that, in this small cohort, patients undergoing peripheral arterial revascularization subjects with small isoforms are at an increased risk of treated vessel occlusion in the perioperative period. Table of Contents Summary Subjects with symptomatic PAD requiring lower extremity revascularization have high median Lp(a) levels. Individuals with smaller apo(a) weighted isoform size (wIS) have lower primary patency rates and/or require re-intervention.
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Vinci P, Fiotti N, Panizon E, Tosoni LM, Cerrato C, Pellicori F, Pirulli A, Altamura N, Schincariol P, Di Girolamo FG, Biolo G. Epidemiology of atherosclerotic cardiovascular disease in polygenic hypercholesterolemia with or without high lipoprotein(a) levels. Front Cardiovasc Med 2024; 10:1272288. [PMID: 38322275 PMCID: PMC10845343 DOI: 10.3389/fcvm.2023.1272288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/08/2023] [Indexed: 02/08/2024] Open
Abstract
Background and aims Epidemiology of atherosclerotic cardiovascular disease might be different in patients with polygenic hypercholesterolemia plus high levels (≥30 mg/dl) of Lp(a) (H-Lpa) than in those with polygenic hypercholesterolemia alone (H-LDL). We compared the incidence of peripheral artery disease (PAD), coronary artery disease (CAD), and cerebrovascular disease (CVD) in patients with H-Lpa and in those with H-LDL. Methods Retrospective analysis of demographics, risk factors, vascular events, therapy, and lipid profile in outpatient clinical data. Inclusion criteria was adult age, diagnosis of polygenic hypercholesterolemia, and both indication and availability for Lp(a) measurement. Results Medical records of 258 patients with H-Lpa and 290 H-LDL were reviewed for occurrence of vascular events. The median duration of follow-up was 10 years (IQR 3-16). In spite of a similar reduction of LDL cholesterol, vascular events occurred more frequently, and approximately 7 years earlier (P = 0.024) in patients with H-Lpa than in H-LDL (HR 1.96 1.21-3.17, P = 0.006). The difference was around 10 years for acute events (TIA, Stroke, acute coronary events) and one year for chronic ones (P = 0.023 and 0.525, respectively). Occurrence of acute CAD was higher in H-Lpa men (HR 3.1, 95% CI 1.2-7.9, P = 0.007) while, among women, PAD was observed exclusively in H-Lpa subjects with smoking habits (P = 0.009). Conclusions Patients with high Lp(a) levels suffer from a larger and earlier burden of the disease compared to those with polygenic hypercholesterolemia alone. These patients are at higher risk of CAD if they are men, and of PAD if they are women.
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Affiliation(s)
- Pierandrea Vinci
- U.C.O. Clinica Medica, Department of Medical, Surgical and Health Sciences, University of Trieste and ASUGI, Trieste, Italy
| | - Nicola Fiotti
- U.C.O. Clinica Medica, Department of Medical, Surgical and Health Sciences, University of Trieste and ASUGI, Trieste, Italy
| | - Emiliano Panizon
- U.C.O. Clinica Medica, Department of Medical, Surgical and Health Sciences, University of Trieste and ASUGI, Trieste, Italy
| | - Letizia Maria Tosoni
- U.C.O. Clinica Medica, Department of Medical, Surgical and Health Sciences, University of Trieste and ASUGI, Trieste, Italy
| | - Carla Cerrato
- U.C.O. Clinica Medica, Department of Medical, Surgical and Health Sciences, University of Trieste and ASUGI, Trieste, Italy
| | - Federica Pellicori
- U.C.O. Clinica Medica, Department of Medical, Surgical and Health Sciences, University of Trieste and ASUGI, Trieste, Italy
| | - Alessia Pirulli
- U.C.O. Clinica Medica, Department of Medical, Surgical and Health Sciences, University of Trieste and ASUGI, Trieste, Italy
| | - Nicola Altamura
- U.C.O. Clinica Medica, Department of Medical, Surgical and Health Sciences, University of Trieste and ASUGI, Trieste, Italy
| | - Paolo Schincariol
- Hospital Pharmacy, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Filippo Giorgio Di Girolamo
- U.C.O. Clinica Medica, Department of Medical, Surgical and Health Sciences, University of Trieste and ASUGI, Trieste, Italy
- Hospital Pharmacy, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Gianni Biolo
- U.C.O. Clinica Medica, Department of Medical, Surgical and Health Sciences, University of Trieste and ASUGI, Trieste, Italy
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Beckman JA, Sullivan AE. Lipoprotein(a), Peripheral Artery Disease, and Abdominal Aortic Aneurysm: The Next Frontier or Another Risk Enhancer? J Am Coll Cardiol 2023; 82:2277-2279. [PMID: 38057069 DOI: 10.1016/j.jacc.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 12/08/2023]
Affiliation(s)
- Joshua A Beckman
- Division of Vascular Medicine, University of Texas Southwestern, Dallas, Texas, USA.
| | - Alexander E Sullivan
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA. https://twitter.com/AlexSullivan_MD
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Thomas PE, Vedel-Krogh S, Nielsen SF, Nordestgaard BG, Kamstrup PR. Lipoprotein(a) and Risks of Peripheral Artery Disease, Abdominal Aortic Aneurysm, and Major Adverse Limb Events. J Am Coll Cardiol 2023; 82:2265-2276. [PMID: 38057068 DOI: 10.1016/j.jacc.2023.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/05/2023] [Accepted: 10/02/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Lp(a) (lipoprotein[a])-lowering therapy to reduce cardiovascular disease is under investigation in phase 3 clinical trials. High Lp(a) may be implicated in peripheral artery disease (PAD), abdominal aortic aneurysms (AAAs), and major adverse limb events (MALE). OBJECTIVES The authors investigated the association of high Lp(a) levels and corresponding LPA genotypes with risk of PAD, AAA, and MALE. METHODS The authors included 108,146 individuals from the Copenhagen General Population Study. During follow-up, 2,450 developed PAD, and 1,251 AAAs. Risk of MALE was assessed in individuals with PAD at baseline and replicated in the Copenhagen City Heart Study. RESULTS Higher Lp(a) was associated with a stepwise increase in risk of PAD and AAA (P for trend <0.001). For individuals with Lp(a) levels ≥99th (≥143 mg/dL, ≥307 nmol/L) vs <50th percentile (≤9 mg/dL, ≤17 nmol/L), multivariable-adjusted HRs were 2.99 (95% CI: 2.09-4.30) for PAD and 2.22 (95% CI: 1.21-4.07) for AAA. For individuals with PAD, the corresponding incidence rate ratio for MALE was 3.04 (95% CI: 1.55-5.98). Per 50 mg/dL (105 nmol/L) genetically higher Lp(a) risk ratios were 1.39 (95% CI: 1.24-1.56) for PAD and 1.21 (95% CI: 1.01-1.44) for AAA, consistent with observational risk ratios of 1.33 (95% CI: 1.24-1.43) and 1.27 (95% CI: 1.15-1.41), respectively. In women smokers aged 70 to 79 years with Lp(a) <50th and ≥99th percentile, absolute 10-year risks of PAD were 8% and 21%, and equivalent risks in men 11% and 29%, respectively. For AAA, corresponding risks were 2% and 4% in women, and 5% and 12% in men. CONCLUSIONS High Lp(a) levels increased risk of PAD, AAA, and MALE by 2- to 3-fold in the general population, opening opportunities for prevention given future Lp(a)-lowering therapies.
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Affiliation(s)
- Peter E Thomas
- Department of Clinical Biochemistry, Copenhagen University Hospital-Herlev and Gentofte, Denmark; The Copenhagen General Population Study, Copenhagen University Hospital-Herlev and Gentofte, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Signe Vedel-Krogh
- Department of Clinical Biochemistry, Copenhagen University Hospital-Herlev and Gentofte, Denmark; The Copenhagen General Population Study, Copenhagen University Hospital-Herlev and Gentofte, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Sune F Nielsen
- Department of Clinical Biochemistry, Copenhagen University Hospital-Herlev and Gentofte, Denmark; The Copenhagen General Population Study, Copenhagen University Hospital-Herlev and Gentofte, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Copenhagen University Hospital-Herlev and Gentofte, Denmark; The Copenhagen General Population Study, Copenhagen University Hospital-Herlev and Gentofte, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pia R Kamstrup
- Department of Clinical Biochemistry, Copenhagen University Hospital-Herlev and Gentofte, Denmark; The Copenhagen General Population Study, Copenhagen University Hospital-Herlev and Gentofte, Denmark.
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Maloberti A, Intravaia RCM, Mancusi C, Cesaro A, Golia E, Ilaria F, Coletta S, Merlini P, De Chiara B, Bernasconi D, Algeri M, Ossola P, Ciampi C, Riccio A, Tognola C, Ardissino M, Inglese E, Scaglione F, Calabrò P, De Luca N, Giannattasio C. Secondary Prevention and Extreme Cardiovascular Risk Evaluation (SEVERE-1), Focus on Prevalence and Associated Risk Factors: The Study Protocol. High Blood Press Cardiovasc Prev 2023; 30:573-583. [PMID: 38030852 PMCID: PMC10721661 DOI: 10.1007/s40292-023-00607-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Despite significant improvement in secondary CardioVascular (CV) preventive strategies, some acute and chronic coronary syndrome (ACS and CCS) patients will suffer recurrent events (also called "extreme CV risk"). Recently new biochemical markers, such as uric acid (UA), lipoprotein A [Lp(a)] and several markers of inflammation, have been described to be associated with CV events recurrence. The SEcondary preVention and Extreme cardiovascular Risk Evaluation (SEVERE-1) study will accurately characterize extreme CV risk patients enrolled in cardiac rehabilitation (CR) programs. AIM Our aims will be to describe the prevalence of extreme CV risk and its association with newly described biochemical CV risk factors. AIM Our aims will be to describe the prevalence of extreme CV risk and its association with newly described biochemical CV risk factors. METHODS We will prospectively enrol 730 ACS/CCS patients at the beginning of a CR program. Extreme CV risk will be retrospectively defined as the presence of a previous (within 2 years) CV events in the patients' clinical history. UA, Lp(a) and inflammatory markers (interleukin-6 and -18, tumor necrosis factor alpha, C-reactive protein, calprotectin and osteoprotegerin) will be assessed in ACS/CCS patients with extreme CV risk and compared with those without extreme CV risk but also with two control groups: 1180 hypertensives and 765 healthy subjects. The association between these biomarkers and extreme CV risk will be assessed with a multivariable model and two scoring systems will be created for an accurate identification of extreme CV risk patients. The first one will use only clinical variables while the second one will introduce the biochemical markers. Finally, by exome sequencing we will both evaluate polygenic risk score ability to predict recurrent events and perform mendellian randomization analysis on CV biomarkers. CONCLUSIONS Our study proposal was granted by the European Union PNRR M6/C2 call. With this study we will give definitive data on extreme CV risk prevalence rising attention on this condition and leading cardiologist to do a better diagnosis and to carry out a more intensive treatment optimization that will finally leads to a reduction of future ACS recurrence. This will be even more important for cardiologists working in CR that is a very important place for CV risk definition and therapies refinement.
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Affiliation(s)
- Alessandro Maloberti
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy.
- Cardiology 4, Cardio Center, ASST GOM Niguarda, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20159, Milan, Italy.
| | | | - Costantino Mancusi
- Cardiac Rehabilitation Unit, Federico II° University Hospital, Naples, Italy
| | | | - Enrica Golia
- S. Anna e S. Sebastiano Hospital, Caserta, Italy
| | - Fucile Ilaria
- Cardiac Rehabilitation Unit, Federico II° University Hospital, Naples, Italy
| | | | - Piera Merlini
- Cardiology 4, Cardio Center, ASST GOM Niguarda, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
| | - Benedetta De Chiara
- Cardiology 4, Cardio Center, ASST GOM Niguarda, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
| | - Davide Bernasconi
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Clinical Research and Innovation, Niguarda Hospital, Milan, Italy
| | - Michela Algeri
- Cardiology 4, Cardio Center, ASST GOM Niguarda, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
| | - Paolo Ossola
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Claudio Ciampi
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Alfonso Riccio
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Chiara Tognola
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Cardiology 4, Cardio Center, ASST GOM Niguarda, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
| | - Maddalena Ardissino
- Cambridge University Hospitals NHS Trust, Cambridge, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Elvira Inglese
- Department of Laboratory Medicine, ASST "Grande Ospedale Metropolitano" Niguarda, 20162, Milan, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, 27100, Pavia, Italy
| | - Francesco Scaglione
- Department of Laboratory Medicine, ASST "Grande Ospedale Metropolitano" Niguarda, 20162, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122, Milan, Italy
| | | | - Nicola De Luca
- Cardiac Rehabilitation Unit, Federico II° University Hospital, Naples, Italy
| | - Cristina Giannattasio
- School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
- Cardiology 4, Cardio Center, ASST GOM Niguarda, Niguarda Hospital, Piazza Ospedale Maggiore 3, 20159, Milan, Italy
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Pasławska A, Tomasik PJ. Lipoprotein(a)-60 Years Later-What Do We Know? Cells 2023; 12:2472. [PMID: 37887316 PMCID: PMC10605347 DOI: 10.3390/cells12202472] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/17/2023] [Accepted: 10/14/2023] [Indexed: 10/28/2023] Open
Abstract
Lipoprotein(a) (Lp(a)) molecule includes two protein components: apolipoprotein(a) and apoB100. The molecule is the main transporter of oxidized phospholipids (OxPL) in plasma. The concentration of this strongly atherogenic lipoprotein is predominantly regulated by the LPA gene expression. Lp(a) is regarded as a risk factor for several cardiovascular diseases. Numerous epidemiological, clinical and in vitro studies showed a strong association between increased Lp(a) and atherosclerotic cardiovascular disease (ASCVD), calcific aortic valve disease/aortic stenosis (CAVD/AS), stroke, heart failure or peripheral arterial disease (PAD). Although there are acknowledged contributions of Lp(a) to the mentioned diseases, clinicians struggle with many inconveniences such as a lack of well-established treatment lowering Lp(a), and common guidelines for diagnosing or assessing cardiovascular risk among both adult and pediatric patients. Lp(a) levels are different with regard to a particular race or ethnicity and might fluctuate during childhood. Furthermore, the lack of standardization of assays is an additional impediment. The review presents the recent knowledge on Lp(a) based on clinical and scientific research, but also highlights relevant aspects of future study directions that would approach more suitable and effective managing risk associated with increased Lp(a), as well as control the Lp(a) levels.
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Affiliation(s)
- Anna Pasławska
- Tuchow Health Center, Medical Hospital Laboratory, Szpitalna St. 1, 33-170 Tuchow, Poland;
| | - Przemysław J. Tomasik
- Department of Clinical Biochemistry, Pediatric Institute, College of Medicine, Jagiellonian University, Wielicka St. 265, 30-663 Cracow, Poland
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Banerjee R, Weideman S, Fernandez-Vazquez D, Banerjee A, Hasan A, Tsai S. Role of Lipoprotein A in Lower Extremity Peripheral Artery Disease. Am J Cardiol 2023; 198:47-49. [PMID: 37201230 DOI: 10.1016/j.amjcard.2023.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/09/2023] [Accepted: 04/13/2023] [Indexed: 05/20/2023]
Affiliation(s)
- Rahul Banerjee
- College of Arts and Sciences, Georgetown University, Washington, District of Columbia
| | - Sarah Weideman
- Baylor Scott & White Heart and Vascular Institute, Dallas, Texas
| | | | - Avantika Banerjee
- Department of Medicine, Medstar Health Georgetown Washington Hospital Center, Washington, District of Columbia
| | - Ahmed Hasan
- National Heart Lung and Blood Institute, Bethesda, Maryland
| | - Shirling Tsai
- Surgical Services, VA North Texas Health Care Systems, Department of Surgery, UT Southwestern Medical Center, Dallas, Texas.
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Maloberti A, Fabbri S, Colombo V, Gualini E, Monticelli M, Daus F, Busti A, Galasso M, De Censi L, Algeri M, Merlini PA, Giannattasio C. Lipoprotein(a): Cardiovascular Disease, Aortic Stenosis and New Therapeutic Option. Int J Mol Sci 2022; 24:ijms24010170. [PMID: 36613613 PMCID: PMC9820656 DOI: 10.3390/ijms24010170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/23/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Atherosclerosis is a chronic and progressive inflammatory process beginning early in life with late clinical manifestation. This slow pathological trend underlines the importance to early identify high-risk patients and to treat intensively risk factors to prevent the onset and/or the progression of atherosclerotic lesions. In addition to the common Cardiovascular (CV) risk factors, new markers able to increase the risk of CV disease have been identified. Among them, high levels of Lipoprotein(a)-Lp(a)-lead to very high risk of future CV diseases; this relationship has been well demonstrated in epidemiological, mendelian randomization and genome-wide association studies as well as in meta-analyses. Recently, new aspects have been identified, such as its association with aortic stenosis. Although till recent years it has been considered an unmodifiable risk factor, specific drugs have been developed with a strong efficacy in reducing the circulating levels of Lp(a) and their capacity to reduce subsequent CV events is under testing in ongoing trials. In this paper we will review all these aspects: from the synthesis, clearance and measurement of Lp(a), through the findings that examine its association with CV diseases and aortic stenosis to the new therapeutic options that will be available in the next years.
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Affiliation(s)
- Alessandro Maloberti
- Cardiology 4, Cardio Center A. De Gasperis, ASST GOM Niguarda, 20162 Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
- Correspondence: ; Tel.: +39-02-644-478-55; Fax: +39-02-644-425-66
| | - Saverio Fabbri
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Valentina Colombo
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Elena Gualini
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | | | - Francesca Daus
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Andrea Busti
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Michele Galasso
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Lorenzo De Censi
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
| | - Michela Algeri
- Cardiology 4, Cardio Center A. De Gasperis, ASST GOM Niguarda, 20162 Milan, Italy
| | | | - Cristina Giannattasio
- Cardiology 4, Cardio Center A. De Gasperis, ASST GOM Niguarda, 20162 Milan, Italy
- School of Medicine and Surgery, Milano-Bicocca University, 20126 Milan, Italy
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Fogacci F, Borghi C, Davinelli S, Scapagnini G, Cicero AFG. Impact of anti-oestrogen therapy on lipoprotein(a) in postmenopausal women: a systematic review and meta-analysis of double-blind placebo-controlled clinical studies. Endocrine 2022; 80:292-302. [PMID: 36542268 DOI: 10.1007/s12020-022-03287-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The potential mechanisms of endocrine therapy for thrombosis remain currently unclear, and more studies are warranted for further investigation and elucidation. However, high plasma concentration of lipoprotein(a) (Lp(a)) is a recognized prothrombotic factor. The aim of our study was to systematically evaluate the effect of different anti-oestrogen therapy on plasma Lp(a) level in postmenopausal women. METHODS A systematic literature search was conducted in multiple electronic databases to identify the randomized, double-blind, placebo-controlled clinical studies on this topic. Effect size for changes in Lp(a) was expressed as mean difference (MD) and 95% confidence intervals (CI). RESULTS Data were pooled from 10 clinical trials comprising 24 treatment arms, which included 2049 women (1128 women in the active-treated arms and 921 women in the control arms). Meta-analysis of data suggested that anti-oestrogen therapy in women significantly reduced Lp(a) [MD = -5.92% (95%CI: -9.05%,-2.8%)]. CONCLUSIONS This observation is of both clinical and pathophysiological relevance, also in view that the identification of molecular determinants and cellular pathways implicated in Lp(a) synthesis and metabolism is still of concern as a critical issue in lipidology and CV prevention.
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Affiliation(s)
- Federica Fogacci
- Hypertension and Cardiovascular Risk Research Group, Medical and Surgical Sciences Department, Sant'Orsola-Malpighi University Hospital, 40138, Bologna, Italy
| | - Claudio Borghi
- Hypertension and Cardiovascular Risk Research Group, Medical and Surgical Sciences Department, Sant'Orsola-Malpighi University Hospital, 40138, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Sergio Davinelli
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Giovanni Scapagnini
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Arrigo F G Cicero
- Hypertension and Cardiovascular Risk Research Group, Medical and Surgical Sciences Department, Sant'Orsola-Malpighi University Hospital, 40138, Bologna, Italy.
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy.
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Kronenberg F. Studies on lipoprotein(a) and outcomes in peripheral arterial disease: One must not compare apples with pears. Atherosclerosis 2022; 363:71-72. [PMID: 36424295 DOI: 10.1016/j.atherosclerosis.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 11/14/2022]
Affiliation(s)
- Florian Kronenberg
- Institute of Genetic Epidemiology, Medical University of Innsbruck, Innsbruck, Austria.
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11
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Guédon AF, De Freminville JB, Mirault T, Mohamedi N, Rance B, Fournier N, Paul JL, Messas E, Goudot G. Association of Lipoprotein(a) Levels With Incidence of Major Adverse Limb Events. JAMA Netw Open 2022; 5:e2245720. [PMID: 36480201 PMCID: PMC9856359 DOI: 10.1001/jamanetworkopen.2022.45720] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE High lipoprotein(a) (Lp[a]) levels are involved in the development of cardiovascular events, particularly in myocardial infarction, stroke, and peripheral artery disease. Studies assessing the Lp(a) levels associated with adverse lower-limb events are lacking. OBJECTIVE To assess the association between Lp(a) levels and incidence of major adverse limb events in unselected hospitalized patients. DESIGN, SETTING, AND PARTICIPANTS This large retrospective monocentric cohort study was conducted from January 1, 2000, to December 31, 2020. Data were derived from the clinical information system of the Hôpital Européen Georges-Pompidou, a Paris-based university hospital. Patients who underwent at least 1 Lp(a) measurement at the center during the study period were included. Patients who had no follow-up data or who had the first Lp(a) measurement after the study outcome had occurred were excluded. Data analyses were performed from May 2021 to January 2022. MAIN OUTCOMES AND MEASURES The primary outcome was the first inpatient major adverse limb event, defined as a major amputation, peripheral endovascular revascularization, or peripheral surgical revascularization, during follow-up. Secondary outcomes included individual components of the primary outcome. Lipoprotein(a) levels were categorized as follows: normal (<50 mg/dL), high (50 to <134 mg/dL), and very high (≥134 mg/dL); to convert Lp(a) values to milligrams per liter, multiply by 0.1. RESULTS A total of 16 513 patients (median [IQR] age, 58.2 [49.0-66.7] years; 9774 men [59.2%]) were included in the cohort. The median (IQR) Lp(a) level was 24 (10.0-60.0) mg/dL. The 1-year incidence of major adverse limb event was 2.44% in the overall population and 4.54% among patients with very high Lp(a) levels. High (adjusted accelerated failure time [AFT] exponential estimate: 0.43; 95% CI, 0.24-0.78; Benjamini-Hochberg-corrected P = .01) and very high (adjusted AFT exponential estimate: 0.17; 95% CI, 0.07-0.40; Benjamini-Hochberg-corrected P < .001) Lp(a) levels were independently associated with an increased risk of major adverse limb event. CONCLUSIONS AND RELEVANCE Results of this study showed that higher Lp(a) levels were independently associated with an increased risk of a major adverse limb event in hospitalized patients. The Lp(a) measurement needs to be taken into account to improve lower-limb vascular risk assessment.
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Affiliation(s)
- Alexis F. Guédon
- Vascular Medicine Department, Georges Pompidou European Hospital, Assistance Publique–Hôpitaux de Paris (APHP), Université Paris Cité, Paris, France
| | - Jean-Baptiste De Freminville
- Vascular Medicine Department, Georges Pompidou European Hospital, Assistance Publique–Hôpitaux de Paris (APHP), Université Paris Cité, Paris, France
| | - Tristan Mirault
- Vascular Medicine Department, Georges Pompidou European Hospital, Assistance Publique–Hôpitaux de Paris (APHP), Université Paris Cité, Paris, France
- Paris Cardiovascular Research Center (PARCC), Institut National de la Santé et de la Recherche Médicale (INSERM) U970, Université Paris Cité, Paris, France
| | - Nassim Mohamedi
- Vascular Medicine Department, Georges Pompidou European Hospital, Assistance Publique–Hôpitaux de Paris (APHP), Université Paris Cité, Paris, France
| | - Bastien Rance
- Department of Medical Informatics, Georges Pompidou European Hospital, APHP, Université Paris Cité, Paris, France
| | - Natalie Fournier
- Biology Department, Biochemistry Laboratory, Georges Pompidou European Hospital, APHP, Université Paris Cité, Paris, France
- Lip(Sys)2-EA7357, Athérosclérose et Macrophages: Impact Des Phospholipides e Des Fonctions Mitochondriales Sur l'efflux du Cholestérol Cellulaire, Université Paris-Saclay, UFR de Pharmacie, Chatenay-Malabry, France
| | - Jean-Louis Paul
- Biology Department, Biochemistry Laboratory, Georges Pompidou European Hospital, APHP, Université Paris Cité, Paris, France
- Lip(Sys)2-EA7357, Athérosclérose et Macrophages: Impact Des Phospholipides e Des Fonctions Mitochondriales Sur l'efflux du Cholestérol Cellulaire, Université Paris-Saclay, UFR de Pharmacie, Chatenay-Malabry, France
| | - Emmanuel Messas
- Vascular Medicine Department, Georges Pompidou European Hospital, Assistance Publique–Hôpitaux de Paris (APHP), Université Paris Cité, Paris, France
- Paris Cardiovascular Research Center (PARCC), Institut National de la Santé et de la Recherche Médicale (INSERM) U970, Université Paris Cité, Paris, France
| | - Guillaume Goudot
- Vascular Medicine Department, Georges Pompidou European Hospital, Assistance Publique–Hôpitaux de Paris (APHP), Université Paris Cité, Paris, France
- Paris Cardiovascular Research Center (PARCC), Institut National de la Santé et de la Recherche Médicale (INSERM) U970, Université Paris Cité, Paris, France
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Tomoi Y, Takahara M, Soga Y, Kodama K, Imada K, Hiramori S, Ando K. Impact of High Lipoprotein(a) Levels on Clinical Outcomes Following Peripheral Endovascular Therapy. JACC Cardiovasc Interv 2022; 15:1466-1476. [PMID: 35863797 DOI: 10.1016/j.jcin.2022.05.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/17/2022] [Accepted: 05/25/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Elevated lipoprotein(a) (Lp[a]) levels are an independent risk factor for the development of atherosclerotic diseases, including peripheral artery disease (PAD). However, their prognostic impact in patients with PAD remains unknown. OBJECTIVES The aim of this study was to examine the prognostic impact of elevated Lp(a) levels in patients with PAD undergoing endovascular therapy (EVT). METHODS In total, 1,169 patients who underwent successful EVT for symptomatic PAD between September 2016 and August 2021 were included in this study. High Lp(a) levels were defined as >30 mg/dL. The associations of high Lp(a) levels with incident major adverse cardiovascular events (MACE) (all-cause death, myocardial infarction, and stroke) and major adverse limb events (MALE) (repeat revascularization for target limb and major amputation) were analyzed. RESULTS During a median follow-up period of 1.7 years (IQR: 0.6-3.0 years), 230 MACE (210 deaths, 15 myocardial infarctions, and 22 strokes) and 263 MALE (219 reinterventions and 36 major amputations) were observed. The cumulative incidence rate of MACE (48.1% vs 27.3%) and MALE (67.9% vs 27.2%) was significantly higher in patients with high Lp(a) levels (P < 0.001 for both). The adjusted HR were 1.93 (95% CI: 1.44-2.59; P < 0.001) for MACE and 4.15 (95% CI: 3.14-5.50; P < 0.001) for MALE. These associations were not influenced by low-density lipoprotein cholesterol levels or statin administration (P for interaction >0.05 for all). CONCLUSIONS Elevated Lp(a) levels were independently associated with incident MACE and MALE in patients with PAD treated with revascularization irrespective of low-density lipoprotein cholesterol level and statin administration.
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Affiliation(s)
- Yusuke Tomoi
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
| | - Mitsuyoshi Takahara
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Kodama
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kazuaki Imada
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Seiichi Hiramori
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
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