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Lp(a) levels not associated with CV events in recent ACS
In patients with recent ACS treated with statins, lipoprotein(a) levels were not linked to CV outcomes, according to new data from the dal-OUTCOMES trial.
As Cardiology Today previously reported, in the main findings of dal-OUTCOMES, the cholesterol ester transfer protein inhibitor dalcetrapib (F. Hoffmann-La Roche) increased HDL levels by 30% in patients with recent ACS but did not affect CV outcomes.
In a new ad hoc analysis of the dal-OUTCOMES cohort, researchers compared Lp(a) levels in 969 patients (mean age, 63 years; 79% men) who had a CV event during the study period (mean follow-up, 31 months) vs. those in 3,170 patients (mean age, 60 years; 89% men) who did not.
Outcomes of interest were CHD death, major nonfatal coronary events (MI, hospitalization for unstable angina or resuscitated cardiac arrest) and fatal or nonfatal ischemic stroke.
Median Lp(a) level at baseline was 12.3 mg/dL (interquartile range, 4.7-50.9), Gregory G. Schwartz, MD, PhD, from the cardiology section of the Veterans Affairs Medical Center and the University of Colorado School of Medicine in Denver, and colleagues wrote.
Statin use was widespread after ACS, with 97% of the cohort using them, according to the researchers.
Cumulative distribution Lp(a) levels at baseline did not differ between the groups (P = .16), and a case-cohort regression analysis did not determine any association of baseline level of Lp(a) with risk for CV events, Schwartz and colleagues wrote.
After adjustment for 16 variables, including assignment to the study drug, the HR for doubling of Lp(a) concentration was 1.01 (95% CI, 0.96-1.06), according to the researchers.
Change in Lp(a) concentration was greater in those assigned dalcetrapib vs. those assigned placebo (P < .001), although Lp(a) decreased by small amounts in both groups, Schwartz and colleagues wrote.
“Although Lp(a) is believed to be an atherogenic lipoprotein, the present analysis indicates that Lp(a) concentration does not predict the risk of ischemic cardiovascular events following ACS among patients who receive current evidence-based therapies,” Schwartz and colleagues wrote. – by Erik Swain
Disclosures: The original dal-OUTCOMES study was funded by F. Hoffman-La Roche. Schwartz reports he received institutional research grants from Cerenis, Resverlogix, Roche, Sanofi and The Medicines Company. Please see the full study for a list of the other authors’ relevant financial disclosures.