High Lp(a) common in patients undergoing CABG; linked to poor outcomes
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Key takeaways:
- Approximately one in five patients who underwent CABG also had high Lp(a).
- High Lp(a) at baseline was associated with increased all-cause mortality and risk for adverse events after surgery.
High lipoprotein(a), a relatively common finding in patients undergoing CABG, was associated with increased risk for all-cause death after surgery, researchers reported.
Risk was especially high among patients with high Lp(a) who received only a saphenous vein graft rather than an arterial graft with and without high Lp(a), according to data published in the Journal of the American Heart Association.
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“The distribution and prognostic implication of lipoprotein(a) in patients undergoing CABG are still largely unknown,” Shuo Yuan, MD, of the National Clinical Research Center of Cardiovascular Diseases at Fuwai Hospital, National Center for Cardiovascular Diseases in Beijing, and colleagues wrote. “Much less attention has been paid to evaluating the influence of lipoprotein(a) on patients undergoing CABG with different levels of LDL-C and different graft materials, which may be possible treatment options in the absence of approved lipoprotein(a)-lowering therapy. The main objective of this study is to assess the association between lipo-protein(a) level and prognosis of patients with stable CAD after isolated CABG in a large prospective cohort.”
For this study, Yuan and colleagues analyzed data from 18,544 consecutive patients with stable CAD who underwent isolated CABG from 2013 to 2018 at Fuwai Hospital in Beijing (mean age, 61 years; 22% women; 46% with diabetes).
The primary outcome was all-cause death and the secondary outcome was a composite of major adverse CV and cerebrovascular events (all-cause death, MI, cerebrovascular accidents or repeated revascularization).
Lp(a) and outcomes after CABG
Overall, 22% of the cohort had high Lp(a), defined as Lp(a) concentrations of 50 mg/dL or more.
During the study period, the proportion of patients with stable CAD undergoing CBAG with high Lp(a) increased from 19% in 2013 to 32.4% in 2018 (P for trend < .001).
Patients identified as having high Lp(a) were more often women and more likely to have peripheral artery disease and three-vessel disease compared with those with low Lp(a), defined as levels less than 50 mg/dL, according to the study.
During a median follow-up of 3.2 years, high Lp(a) was associated with increased risk for all- cause death (adjusted HR = 1.31; 95% CI, 1.09-1.59; P = .005) compared with lower Lp(a), with an increased HR of 1.003 for every 1 mg/dL increase in Lp(a) (95% CI, 1.001-1.006; P = .011).
In addition, risk for MACCE was also greater among patients with high Lp(a) compared with low Lp(a) (aHR = 1.18; 95% CI, 1.06-1.33; P = .004), with an increased aHR of 1.002 for every 1 mg/dL increase in Lp(a) (95% CI, 1.001-1.004; P = .002).
Impact of graft material on Lp(a)-associated risk
High Lp(a) was associated with an increased risk for all-cause death in patients with EuroSCORE less than 3 and less so among those with a score higher than 3 (P for interaction = .001), according to the study.
Moreover, after patients were stratified by Lp(a) level and arterial graft type, the researchers observed that patients with high Lp(a) and only a saphenous vein graft had higher event rates compared with patients without high Lp(a) who received only a saphenous vein graft and those with and without high Lp(a) who received an arterial graft.
“Considering lipoprotein(a) is relatively low in Chinese compared with other ethnic groups, it is reasonable to assume that elevated lipoprotein(a) is not uncommon in general patients undergoing CABG worldwide,” the researchers wrote. “Surprisingly, we found that lipoprotein(a)-related cardiovascular risk was attenuated in patients who received arterial grafts. ... Our study highlights the importance of the usage of arterial grafts and standardized training, especially in an era when the prevalence of elevated lipoprotein(a) is high and gradually increasing.”
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