Background

Elevated lipoprotein(a) (Lp[a]) levels are an independent risk factor for the development of atherosclerotic diseases, including peripheral artery disease (PAD). However, their prognostic impact in patients with PAD remains unknown.

Objectives

The aim of this study was to examine the prognostic impact of elevated Lp(a) levels in patients with PAD undergoing endovascular therapy (EVT).

Methods

In total, 1,169 patients who underwent successful EVT for symptomatic PAD between September 2016 and August 2021 were included in this study. High Lp(a) levels were defined as >30 mg/dL. The associations of high Lp(a) levels with incident major adverse cardiovascular events (MACE) (all-cause death, myocardial infarction, and stroke) and major adverse limb events (MALE) (repeat revascularization for target limb and major amputation) were analyzed.

Results

During a median follow-up period of 1.7 years (IQR: 0.6-3.0 years), 230 MACE (210 deaths, 15 myocardial infarctions, and 22 strokes) and 263 MALE (219 reinterventions and 36 major amputations) were observed. The cumulative incidence rate of MACE (48.1% vs 27.3%) and MALE (67.9% vs 27.2%) was significantly higher in patients with high Lp(a) levels (P < 0.001 for both). The adjusted HR were 1.93 (95% CI: 1.44-2.59; P < 0.001) for MACE and 4.15 (95% CI: 3.14-5.50; P < 0.001) for MALE. These associations were not influenced by low-density lipoprotein cholesterol levels or statin administration (P for interaction >0.05 for all).

Conclusions

Elevated Lp(a) levels were independently associated with incident MACE and MALE in patients with PAD treated with revascularization irrespective of low-density lipoprotein cholesterol level and statin administration.

中文翻译：

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高脂蛋白（a）水平对外周血管内治疗后临床结果的影响

背景

升高的脂蛋白 (a) (Lp[a]) 水平是动脉粥样硬化疾病发展的独立危险因素，包括外周动脉疾病 (PAD)。然而，它们对 PAD 患者的预后影响仍然未知。

目标

本研究的目的是检查 Lp(a) 水平升高对接受血管内治疗 (EVT) 的 PAD 患者的预后影响。

方法

总共有 1,169 名在 2016 年 9 月至 2021 年 8 月期间因症状性 PAD 成功接受 EVT 的患者被纳入本研究。高 Lp(a) 水平定义为 >30 mg/dL。分析了高 Lp(a) 水平与主要不良心血管事件 (MACE)（全因死亡、心肌梗死和中风）和主要不良肢体事件 (MALE)（目标肢体的重复血运重建和主要截肢）的关联.

结果

在 1.7 年的中位随访期间（IQR：0.6-3.0 年），观察到 230 例 MACE（210 例死亡、15 例心肌梗死和 22 例卒中）和 263 例男性（219 例再次干预和 36 例大截肢）。高 Lp(a) 水平患者的 MACE（48.1% vs 27.3%）和 MALE（67.9% vs 27.2%）的累积发生率显着更高（两者P  < 0.001）。MACE的调整后 HR 为 1.93（95% CI：1.44-2.59 ； P < 0.001），MALE 为 4.15（95% CI：3.14-5.50；P  < 0.001）。这些关联不受低密度脂蛋白胆固醇水平或他汀类药物给药的影响（所有相互作用的P > 0.05）。

结论

无论低密度脂蛋白胆固醇水平和他汀类药物使用情况如何，在接受血运重建治疗的 PAD 患者中，升高的 Lp(a) 水平与事件 MACE 和 MALE 独立相关。