SERIAL INCREASES IN CIRCULATING LIPOPROTEIN(A) LEVELS PREDICT ACUTE CARDIOVASCULAR EVENTS

초록

Background and Aims: Lipoprotein(a) [Lp(a)] has been considered an independent risk factor for atherosclerotic vascular disease. However, its clinical significance as a screening tool for acute cardiovascular events (CVE) has been inconsistent because of the variations in absolute values of Lp(a) in different races and individuals. We investigated the correlation of serial increase in circulating Lp(a) levels with the development of acute CVE. Methods: We prospectively investigated 985 (464 women and 521 men) consecutive participants who have either clinically evident vascular disease (vascular disease group, n¼443) [chronic stable angina (n¼330), cerebral infarct (n¼72), and peripheral arterial disease (n¼41)] or its risk factor(s) (Risk factor group, n¼542). All participants took blood samples every six months to measure Lp(a), high sensitive C-reactive protein, white blood cell count, erythrocyte sedimentation rate, and fibrinogen during the 10-year follow-up period (mean follow-up of 6.2 4.5 years). Delta Lp(a) was defined as the last Lp(a) concentration before CVE subtracted by the one before the last Lp(a) concentration. Results: During the 10-year follow-up, 223 new cases of myocardial infarction, stroke, and peripheral arterial disease were identified. Positive delta Lp(a), which was defined as serial increase > 2.5 mg/dl, was associated with a significant increase in CVE in both vascular disease group [relative risk(RR) 6.35, 95% CI 1.69-13.41, p¼0.005] and risk factor group [RR 4.81, 95% CI 1.69-8.08, p¼0.032] (Figure 1). Conclusions: Serially increasing change in Lp(a) concentration is a highly predictive value in CVE regardless of prior history of cardiovascular disease.