Lipoprotein (a) as a predictor of the possibility of multifocal atherosclerosis in patients with stable CHD in the post-COVID period

Objective. The study aims to investigate the relationship between the severity of COVID-19 and the course of stable coronary heart disease (CHD), as well as to evaluate the role of lipoprotein(a) [LP(a)] as a predictor of multifocal atherosclerosis in patients during the post-COVID period. Material and methods . 431 patients with stable coronary heart disease (CHD) who had confirmed COVID-19 infections lasting between 3 to 18 months were examined. Patients were divided into two groups according to the severity of COVID-19: Group 1 included 203 patients with mild COVID-19 and Group 2 included 228 patients with moderate COVID-19 in the acute period. Clinical, laboratory and instrumental diagnostic methods including lipid profile indices (apolipoprotein A1 (apoA1), B (apoB), lipoprotein (a) (Lp(a)) and coronary angiography to assess the extent of atherosclerosis were used in the study. Logistic regression method was used to identify predictors of multifocal atherosclerosis (MFA) based on comprehensive analysis of clinical data. Results . CHD patients with a moderately severe course of acute COVID-19 in the post-COVID period were characterised by more pronounced altered indices of lipid and carbohydrate metabolism, as well as a higher frequency of hemodynamically significant coronary artery lesions, leading to a worsening of the course of the CHD and an increased risk of complications. They were significantly more likely have uncontrolled arterial hypertension (p < 0.001), atrial fibrillation (p = 0.035) and type 2 diabetes (p = 0.007), and higher levels of such biomarkers as the terminal fragment of brain natriuretic peptide precursor (p < 0.001), glycated haemoglobin (HbA1c) (p = 0.005), apoA1 (p < 0.001), lower apoB/A1 ratio (p = 0.04) and higher Lp(a) concentration (p < 0.001). Construction of multivariate logistic regression model found that in patients with stable CHD in the post-COVID period, Lp(a) level > 317.56 μg/ml increased the risk of MFA by 2.74 times, apoA1 level > 199.4 mg/dl – by 5.27 times, level, HbA1c > 5.85 % – by 8 times, left ventricular mass index > 122.23 in g/m 2 – by 1.92 times, male sex – by 2.92 times. Conclusions . The obtained data suggest that patients with stable CHD who underwent COVID-19 of medium severity in the acute stage of the infectious process represent a risk group of subsequent more severe course of the underlying disease.