Alexander Vonbank1, Christoph H Saely1, Philipp Rein1, Daniela Zanolin1, Heinz Drexel1. 1. Department of Medicine and Cardiology, Vorarlberg Institute for Vascular Investigation and Treatment (A.V., C.H.S., P.R., D.Z, H.D.), Feldkirch 6800, Austria; Department of Medicine and Cardiology (A.V., C.H.S., P.R., D.Z, H.D.), Academic Teaching Hospital Feldkirch, Feldkirch 6800, Austria; Private University of the Principality of Liechtenstein (A.V., C.H.S., P.R., D.Z, H.D.), Triesen 9495, Liechtenstein; Department of Medicine, Drexel University College of Medicine (H.D.), Philadelphia, Pennsylvania 19129.
Abstract
BACKGROUND: Lipoprotein (a) [Lp(a)] especially in young individuals, is an important cardiovascular risk factor. However, data on the vascular risk conferred by Lp(a) in patients with the metabolic syndrome (MetS) are not available. METHODS: Lp(a) was measured in a cohort of 593 consecutive patients undergoing coronary angiography for the evaluation of stable coronary artery disease. MetS was diagnosed according to International Diabetes Federation criteria. Vascular events were recorded over 10 years. RESULTS: Median Lp(a) was significantly lower in patients with the MetS (n = 307) than in subjects who did not have the MetS (12 [interquartile range, 0-35] mg/dl vs 17 [0-57] mg/dl; P = .004). Prospectively, 34% of our patients suffered vascular events. Lp(a) proved to be a strong and independent predictor of vascular events in subjects without the MetS (standardized adjusted hazard ratio [HR], 1.20 [1.05-1.38]; P = .006) but not in patients who had the MetS (HR, 0.96 [0.77-1.20]; P = .713). An interaction term MetS × Lp(a) was significant (P = .029), indicating that Lp(a) was a significantly stronger predictor of vascular events in subjects without the MetS than in patients with the MetS. CONCLUSIONS: Lp(a) in patients with the MetS is low and is not associated with the incidence of vascular events. The power of Lp(a) as a predictor of cardiovascular events is significantly modulated by the presence of the MetS.
BACKGROUND: Lipoprotein (a) [Lp(a)] especially in young individuals, is an important cardiovascular risk factor. However, data on the vascular risk conferred by Lp(a) in patients with the metabolic syndrome (MetS) are not available. METHODS:Lp(a) was measured in a cohort of 593 consecutive patients undergoing coronary angiography for the evaluation of stable coronary artery disease. MetS was diagnosed according to International Diabetes Federation criteria. Vascular events were recorded over 10 years. RESULTS: Median Lp(a) was significantly lower in patients with the MetS (n = 307) than in subjects who did not have the MetS (12 [interquartile range, 0-35] mg/dl vs 17 [0-57] mg/dl; P = .004). Prospectively, 34% of our patients suffered vascular events. Lp(a) proved to be a strong and independent predictor of vascular events in subjects without the MetS (standardized adjusted hazard ratio [HR], 1.20 [1.05-1.38]; P = .006) but not in patients who had the MetS (HR, 0.96 [0.77-1.20]; P = .713). An interaction term MetS × Lp(a) was significant (P = .029), indicating that Lp(a) was a significantly stronger predictor of vascular events in subjects without the MetS than in patients with the MetS. CONCLUSIONS:Lp(a) in patients with the MetS is low and is not associated with the incidence of vascular events. The power of Lp(a) as a predictor of cardiovascular events is significantly modulated by the presence of the MetS.
Authors: Nikolaus Buchmann; Till Ittermann; Ilja Demuth; Marcello R P Markus; Henry Völzke; Marcus Dörr; Nele Friedrich; Markus M Lerch; Raul D Santos; Sabine Schipf; Elisabeth Steinhagen-Thiessen Journal: Dtsch Arztebl Int Date: 2022-04-15 Impact factor: 8.251
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