Abstract Background There are few data regarding the long-term prognosis of young survivors of acute coronary syndrome (ACS) according to lipoprotein(a) Lp(a) levels. We explored whether Lp(a) ≥70 mg/dL or ≥175 nmol/L, i.e. the cut off level applied by the ongoing phase 3 Lp(a) HORIZON trial, is associated with adverse cardiovascular outcome. Methods We recruited 410 consecutive patients who had survived their first ACS 40 years of age. Clinical end points included all major adverse cardiovascular events (MACE): cardiac death, readmission for ACS, arrhythmias requiring hospital admission, ischaemic stroke or coronary revascularization due to clinical deterioration. Cox regression and Kaplan-Meier analyses were used to assess study outcomes. Results The most prevalent risk factor at presentation was smoking (92.4%) and the majority of patients were men (84.5%). Follow-up data were obtained from 380 patients (age: 33.7± 4.3 years). The median follow-up period was 8 (5.2-12.5) years. One hundred fifty-eight (41.6%) patients reported continuation of smoking during follow-up and 139 (36.6%) had a MACE (18 cardiac death, 89 ACS, 23 revascularization due to clinical deterioration, 8 arrhythmias and one ischaemic stroke). Univariate Cox regression analysis showed that continuation of smoking, left ventricular ejection fraction (LVEF), and Lp(a) levels ≥70 mg/dL were predictors of MACE. Lp(a) levels ≥70 mg/dL remained an independent predictor of MACE after adjustments for LVEF, smoking persistence and traditional risk factors (sex, diabetes mellitus, hypercholesterolaemia, hypertension and family history of premature coronary artery disease) hazard ratio 2.013, 95% CI 1.199-3.381, p=0.008. Figure 1 presents the unadjusted event-free Kaplan-Meier survival curves according to Lp(a) levels (≥ 70 mg/dL vs 70 mg/dL) log-rank=0.005. Conclusions Lp(a) ≥70 mg/dL is an independent long-term predictor for MACE among young survivors of premature ACS.
Rallidis et al. (Sat,) studied this question.