Hyperlipoproteinemia(a) and its impact on prognosis in patients with acute coronary syndrome

Background. Lipoprotein(a) [Lp(a)] is an independent risk factor of ischemic heart disease, peripheral atherosclerosis, ischemic stroke, and aortic valve calcification. The relationship between elevated Lp(a) and recurrent cardiovascular events (CVE) among patients who have experienced acute coronary syndrome (ACS) remains a matter of debate. Objective. To investigate the role of Lp(a) in recurrent CVE within one year after discharge in patients with ACS. Material and methods. The study included patients with ST-segment elevation acute myocardial infarction, non-ST-segment elevation myocardial infarction and unstable angina. Incidence of composite endpoint and individual events was analyzed. Results. We followed-up 446 patients over a 12-month period including 267 men (59.9%) and 179 women (40.1%). The median age was 67 years [58; 75]. The composite endpoint (recurrent ACS, repeat percutaneous coronary interventions, cardiovascular mortality) was recorded in 20.9% (n=93) of patients. The risk ratio for non-fatal CVE, adjusted for sex, age, final diagnosis, initial Killip class, troponin I, diabetes mellitus, left ventricular ejection fraction, three-vessel coronary artery disease and aortic valve stenosis was found to be 1.005 (95% CI: 1.001—1.008) for serum Lp(a). Thus, Lp(a) increase by each 1 mg/dL is associated with significantly higher risk of non-fatal CVE by 0.5%. Conclusion. Analysis of serum Lp(a) is important in patients with ACS. This lipoprotein may be considered a potential risk stratification factor for recurrent cardiovascular events within one year following ACS.