Highlights
- •Both high and very low concentrations of Lp(a) are associated with an increased risk of total mortality and recurrent cardiovascular events after myocardial infarction type I.
- •The excess of mortality associated with Lp(a) is partially attributable to more prevalent heart failure.
Abstract
Background
Inconclusive data exist on risk associated with Lp(a) in patients after myocardial
infarction (MI). Aims of the present study were to evaluate the association of Lp(a)
level with total mortality and recurrent cardiovascular events.
Design and methods
Single center prospective registry of consecutive patients hospitalized for acute
myocardial infarction between June 2017 and June 2020 at a large tertiary cardiac
center with available blood samples drawn <24h of admission.
Results
Data from 851 consecutive patients hospitalized for MI were evaluated. During the
median follow-up of 19 months (interquartile range 10–27), 58 (6.8%) patients died.
Nonlinear modelling revealed a U-shaped association between Lp(a) and total mortality
risk. Compared to patients with Lp(a) ranging between 10-30 nmol/L and after multivariate
adjustment, total mortality risk was increased both in patients with Lp(a)<7 nmol/L
(hazard ratio (HR) 4.08, 95% confidence interval (CI) 1.72–9.68) and Lp(a) ≥125 nmol/L
(HR 2.92, 95% CI 1.16–7.37), respectively. Similarly, the risk of combined endpoint
of acute coronary syndrome recurrence or cardiovascular mortality was increased both
in patients with low (sub-HR 2.60, 95% CI 1.33–5.08) and high (sub-HR 2.10, 95% CI
1.00–4.39) Lp(a). Adjustment for heart failure signs at the time of hospitalization
weakened the association with total mortality and recurrent cardiovascular events.
Conclusions
In the present analysis, both high and low concentrations of Lp(a) were associated
with an increased risk of total mortality and recurrent cardiovascular events after
MI. The excess of mortality associated with Lp(a) was partially attributable to more
prevalent heart failure.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: May 07, 2021
Accepted:
April 18,
2021
Received in revised form:
April 12,
2021
Received:
December 30,
2020
Identification
Copyright
© 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
