Is Lipoprotein(a) a Predictor of Cardiovascular Events After Acute ST Elevation Myocardial Infarction?
Abstract
Background. The role of lipoprotein (a)/Lp(a) as a risk factor for coronary artery disease has abundantly observed in various prospective and retrospective studies. However there is still lack of evidence about its role in thrombotic process, particularly acute coronary syndrome. Hence, this study was conducted to observe the role of high Lp(a) level on cardiovascular event in post acute ST elevation myocardial infarction (STEMI) patients.Methods and results.A cohort study was conducted by enrolling 110 STEMI patients (mean age 53.3 ± 8 years) eligible for fibrinolytic therapy. Respondents were observed from January 2003 to May 31st 2005 (average observation period was 432 days). Recurrent angina, reinfarction, revascularization within 6 months after admission and death were defined as end points of the study. Lp(a) measurement were done from blood sample taken within 24 hours after onset of infarction. Respondents were divided into three groups according to level of Lp(a) percentiles. The highest percentile (> 75%) was (Lp(a) level of > 26.4 mg/dL) and the lowest percentile (<25%) was (Lp(a) level of < 7.2 mg/dL Survival analysis of composite cardiovascular events showed that the highest percentile group failed to show lower cumulative survival compared to the lowest percentile group; hazard ratio of 0.69 (95% CI 0. 29-1.63; p=0. 40). This phenomena was also observed in survival analysis of death; hazard ratio of 0.92 (95% CI 0.13-6.58; p=0.190).
Conclusions. It was concluded that high level of Lp(a) was not a predic-tor of cardio-vascular event following acute STEMI.
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References
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Cantin B, Gagnon F, Moorjani S, Despres JP, Lamarche B, Lupien PJ, et al. Is lipoprotein(a) an independent risk factor for ischaemic heart disease in men ? The Quebec Cardiovascular Study. J Am Coll Cardiol 1998;31:519-25.
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Puckey L, Knight B. Dietary and genetic interactions in the regulation of plasma lipoprotein(a). Curr Opin Lipidol 1999;10:35-40.
Ciccarese M, Tonolo G, Brizzi P, Secchi G, Garrucciu G, Spanedda M, et al. Serum apolipoprotein(a) concentrations and apo(a) phenotypes in patients with liver cirrhosis. Am J Gastroenterol 1998;93:1505-09.
Knight BL, Perombelon YF, Soutar AF, Wade DP, Seed M. Catabolism of lipoprotein(a) in familial hypercholesterolaemic subjects. Atherosclerosis 1991;87:227-37.
Kostner KM, Maurer G, Huber K, Stefenelli T, Dieplinger H, Steyrer E, et al. Urinary excretion of apo(a) fragments : role in apo(a) catabolism. Arterioscler Thromb Vasc Biol 1996; 16:905-11.
Kostner KM, Clodi M, Bodlaj G, Watschinger B, Horl W, Derfler K, et al. Decreased urinary apolipoprotein(a) excretion in patients with impaired renal function. Eur J Clin Invest 1998;28:447-52.
Scanu M. Lp(a) lipoprotein – coping with heterogeneity. N Engl J Med 2003;349:2089-90.
Timmis A. Acute coronary syndrome risk stratification. Heart 2000;83:241-246.
Heller RF, Chinn S, Tunstall-Pedoe HD, Rose G. How well can we predict coronary heart disease ? Br Med J 1984;288: 410-11.
Doughty M, Mehta R, Bruckman D, Das S, Karavite D, Tsai T, et al. et al. Acute myocardial infarction in the young. The University of Michigan experience. Am Heart J 2002;143:56-62.
Koenig W. Haemostatic risk factors for cardiovascular diseases. Eur Heart J 1998;19(suppl. C):C39-C43.
Rosengren A, Wilhelmsen L, Eriksson E, Risberg B, Wedel H. Lipoprotein(a) and coronary heart disease: a prospective case-control study in a general population of middle-aged men. Br Med J 1991;301:1248-51.
Schaefer EJ, Lamon-Fava S, Jenner JL, McNamara JR, Ordovas JM, Davis E, et al. Lipoprotein(a) levels and risk of coronary heart disease in men. The Lipid Research Clinics Coronary Primary Prevention Trial. JAMA 1994;271:999-1003.
Lison L. Peranan lipoprotein(a) pada penyakit jantung koroner. Tesis. Jakarta, FKUI-1998.
Moliterno DJ, Lange RA, Meidell RS, Willard JE, Leffert CC, Gerard RD, et al. Relation of plasma lipoprotein(a) to infarct artery patency in survivors of myocardial infarction. Circulation 1993;88:935-940
Sharret AR, Ballantyne CM, Coady SA, Heiss G, Sorlie PD, Catellier D, et al. Coronary heart disease prediction from lipoprotein cholesterol levels, triglycerides, lipoprotein(a), apolipoproteins A-I and B, and HDL density subfractions. The Atherosclerosis Risk in Communities (ARIC) Study. Circulation 2001;104:1108-13.
Rifai N, Ma J, Sacks FM, Ridker PM, Hernandez WJL, Stampfer MJ, et al. Apolipoprotein(a) size and lipoprotein(a) concentration and future risk of angina pectoris with evidence of severe coronary atherosclerosis in men : The Physicians’ Health Study. Clin Chem 2004;50:1364-71.
Kinlay S, Dobson AJ, Heller RF, McElduff P, Alexander H, Dickeson J. Risk of primary and recurrent acute myocardial infarction from lipoprotein(a) in men and women. J Am Coll Cardiol 1996;28:870-5.
Cantin B, Gagnon F, Moorjani S, Despres JP, Lamarche B, Lupien PJ, et al. Is lipoprotein(a) an independent risk factor for ischaemic heart disease in men ? The Quebec Cardiovascular Study. J Am Coll Cardiol 1998;31:519-25.
Stubbs P, Seed M, Lane D, Collinson P, Kendall F, Noble M. Lipoprotein(a) as a risk predictor for cardiac mortality in patients with acute coronary syndromes. Eur Heart J 1998;19:1355-64.
Morrow D, Antman E, Parson L, De Lemos J, Cannon C, Giugliano R, et al. Application of the TIMI risk score for ST-elevation MI in the National Registry of Myocardial Infarction. JAMA 2001;286:1356-59.
Berg K. A new serum type system in man : the Lp system. Acta Pathol Microbiol Scand 1963;59:211-20.
Kostner KM, Kostner GM. Lipoprotein(a) : still an enigma? Curr Opin Lipidol 2002;13:391-96.
Mc Lean JW, Tomlinson JE, Kuang WJ, Eaton DL, Chen EY, Fless GM, et al. cDNA sequence of human apolipoprotein(a) is homologous to plasminogen. Nature 1987;300:132-37.
Cannon CP, Battler A, Brindis RG, Cox JL, Ellis SG, Every NR, et al. ACC Key Elements and Data Definitions for Measuring the Clinical Management and Outcomes of patients with Acute Coronary Syndromes : a report of the American College of Cardiology Task Force on Clinical Data Standards (Acute Coronary Syndromes Writing Committee). J Am Coll Cardiol 2001;38:2114-30.
Puckey L, Knight B. Dietary and genetic interactions in the regulation of plasma lipoprotein(a). Curr Opin Lipidol 1999;10:35-40.
Ciccarese M, Tonolo G, Brizzi P, Secchi G, Garrucciu G, Spanedda M, et al. Serum apolipoprotein(a) concentrations and apo(a) phenotypes in patients with liver cirrhosis. Am J Gastroenterol 1998;93:1505-09.
Knight BL, Perombelon YF, Soutar AF, Wade DP, Seed M. Catabolism of lipoprotein(a) in familial hypercholesterolaemic subjects. Atherosclerosis 1991;87:227-37.
Kostner KM, Maurer G, Huber K, Stefenelli T, Dieplinger H, Steyrer E, et al. Urinary excretion of apo(a) fragments : role in apo(a) catabolism. Arterioscler Thromb Vasc Biol 1996; 16:905-11.
Kostner KM, Clodi M, Bodlaj G, Watschinger B, Horl W, Derfler K, et al. Decreased urinary apolipoprotein(a) excretion in patients with impaired renal function. Eur J Clin Invest 1998;28:447-52.
Scanu M. Lp(a) lipoprotein – coping with heterogeneity. N Engl J Med 2003;349:2089-90.
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How to Cite
Rini, N., Kasim, M., & Karo Karo, S. (1). Is Lipoprotein(a) a Predictor of Cardiovascular Events After Acute ST Elevation Myocardial Infarction?. Indonesian Journal of Cardiology, 28(3), 171-180. https://doi.org/10.30701/ijc.v28i3.238
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