Key result
Lipoprotein (a) independently predicted vascular events in coronary patients without metabolic syndrome (HR 1.20; 95% CI 1.05-1.38; P=0.006), but not in those with it.
Why the study?
Does the presence of metabolic syndrome modulate the predictive value of Lipoprotein (a) for vascular events in patients with stable coronary artery disease?
Cohort (n=593)
Does the presence of metabolic syndrome modulate the predictive value of Lipoprotein (a) for vascular events in patients with stable coronary artery disease?
Lp(a) is a significant predictor of vascular events in patients with stable coronary artery disease without metabolic syndrome, but loses its predictive power in those with metabolic syndrome.
Lp(a) testing should not yet guide risk assessment in CAD with metabolic syndrome; leaves open differential predictive value by metabolic status.
BACKGROUND: Lipoprotein (a) [Lp(a)] especially in young individuals, is an important cardiovascular risk factor. However, data on the vascular risk conferred by Lp(a) in patients with the metabolic syndrome (MetS) are not available. METHODS: Lp(a) was measured in a cohort of 593 consecutive patients undergoing coronary angiography for the evaluation of stable coronary artery disease. MetS was diagnosed according to International Diabetes Federation criteria. Vascular events were recorded over 10 years. RESULTS: Median Lp(a) was significantly lower in patients with the MetS (n = 307) than in subjects who did not have the MetS (12 [interquartile range, 0-35] mg/dl vs 17 [0-57] mg/dl; P = .004). Prospectively, 34% of our patients suffered vascular events. Lp(a) proved to be a strong and independent predictor of vascular events in subjects without the MetS (standardized adjusted hazard ratio [HR], 1.20 [1.05-1.38]; P = .006) but not in patients who had the MetS (HR, 0.96 [0.77-1.20]; P = .713). An interaction term MetS × Lp(a) was significant (P = .029), indicating that Lp(a) was a significantly stronger predictor of vascular events in subjects without the MetS than in patients with the MetS. CONCLUSIONS: Lp(a) in patients with the MetS is low and is not associated with the incidence of vascular events. The power of Lp(a) as a predictor of cardiovascular events is significantly modulated by the presence of the MetS.
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Vonbank et al. (2016) conducted a cohort in stable coronary artery disease (n=593). Lipoprotein (a) was evaluated on vascular events (HR 1.20, 95% CI 1.05-1.38, p=0.006). Lipoprotein (a) independently predicted vascular events in coronary patients without metabolic syndrome (HR 1.20; 95% CI 1.05-1.38; P=0.006), but not in those with it.
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