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Lipoprotein(a) in Atherosclerotic Diseases: From Pathophysiology to Diagnosis and Treatment. Molecules 2023; 28:molecules28030969. [PMID: 36770634 PMCID: PMC9918959 DOI: 10.3390/molecules28030969] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
Lipoprotein(a) (Lp(a)) is a low-density lipoprotein (LDL) cholesterol-like particle bound to apolipoprotein(a). Increased Lp(a) levels are an independent, heritable causal risk factor for atherosclerotic cardiovascular disease (ASCVD) as they are largely determined by variations in the Lp(a) gene (LPA) locus encoding apo(a). Lp(a) is the preferential lipoprotein carrier for oxidized phospholipids (OxPL), and its role adversely affects vascular inflammation, atherosclerotic lesions, endothelial function and thrombogenicity, which pathophysiologically leads to cardiovascular (CV) events. Despite this crucial role of Lp(a), its measurement lacks a globally unified method, and, between different laboratories, results need standardization. Standard antilipidemic therapies, such as statins, fibrates and ezetimibe, have a mediocre effect on Lp(a) levels, although it is not yet clear whether such treatments can affect CV events and prognosis. This narrative review aims to summarize knowledge regarding the mechanisms mediating the effect of Lp(a) on inflammation, atherosclerosis and thrombosis and discuss current diagnostic and therapeutic potentials.
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Kimura T, Akahori H, Tanaka T, Yanaka K, Yoshihara N, Miki K, Imanaka T, Asakura M, Ishihara M. Impact of lipoprotein (a) on long-term outcome after percutaneous coronary intervention in the era of new generation drug-eluting stents. J Cardiol 2022; 80:179-183. [DOI: 10.1016/j.jjcc.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 02/18/2022] [Accepted: 02/26/2022] [Indexed: 11/26/2022]
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Wu B, Zhao H, Liu C, Lu H, Liu R, Long J, Zhang Z, Zeng F. Association of lipoprotein (a) and in-hospital outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Postgrad Med 2020; 133:195-201. [PMID: 33131368 DOI: 10.1080/00325481.2020.1845517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objective: The current study was to evaluate the association of Lipoprotein (a) [Lp(a)] and in-hospital outcomes in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).Methods: ACS patients undergoing PCI were retrospectively enrolled. Based on Lp(a) level, patients were divided into low (<30 mg/dL) and high (≥30 mg/dL) Lp(a) groups.Results: Compared to those with low Lp(a), patients with high Lp(a) had larger numbers of coronary arteries ≥70% stenosis and had longer coronary artery lesion (P < 0.05). After adjustment for covariates, high Lp(a) remained associated with higher odds of having coronary artery ≥70% stenosis, type C coronary lesion and pre-PCI TIMI flow grade 1/0. Patients with high Lp(a) had a higher unadjusted odds of acute stent thrombosis (odds ratio [OR] 1.10 and 95% confidence interval [CI] 1.01-2.27), congestive heart failure (OR 1.24 and 95% CI 1.15-2.38) and composite in-hospital outcomes (OR 1.28 and 95% CI 1.18-2.42). After adjustment for covariates, patients with high Lp(a) still had a higher odds of congestive heart failure (OR 1.08 and 95% CI 1.01-1.78) and composite in-hospital outcomes (OR 1.12 and 95% CI 1.04-1.81).Conclusion: In ACS patients undergoing PCI, compared to those with low Lp(a), patients with high Lp(a) had more severe coronary artery lesion, higher risk of congestive heart failure and composite in-hospital outcomes.
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Affiliation(s)
| | | | | | - Hao Lu
- Department of Cardiology, Fuwai Hospital Chinese Academy Science of Medical Science, Shenzhen, Guangdong, China
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Tok D, Turak O, Yayla Ç, Ozcan F, Tok D, Çağlı K. Monocyte to HDL ratio in prediction of BMS restenosis in subjects with stable and unstable angina pectoris. Biomark Med 2016; 10:853-60. [PMID: 27415579 DOI: 10.2217/bmm-2016-0071] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
AIM This study aims to assess the predictive role of the preprocedural circulating monocyte to high-density lipoprotein (HDL) cholesterol ratio (MHR) on the occurrence of stent restenosis (SR) in patients with stable and unstable angina pectoris undergoing successful bare-metal stenting (BMS). PATIENTS & METHODS Between February 2008 and June 2014, a total of 831 patients with stable and unstable angina pectoris who underwent successful BMS were retrospectively analyzed. Demographic and clinical characteristics of the patients were recorded. Left ventricular ejection fraction and laboratory data were also noted. RESULTS In the receiver operating characteristics curve analysis, MHR >14 had 71% sensitivity and 69% specificity in predicting SR. CONCLUSION Our study results show that preprocedural MHR is an independent predictor of SR in this patient population.
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Affiliation(s)
- Derya Tok
- Department of Cardiology, Türkiye Yüksek İhtisas Education & Research Hospital, Ankara, Turkey
| | - Osman Turak
- Department of Cardiology, Türkiye Yüksek İhtisas Education & Research Hospital, Ankara, Turkey
| | - Çağrı Yayla
- Department of Cardiology, Türkiye Yüksek İhtisas Education & Research Hospital, Ankara, Turkey
| | - Fırat Ozcan
- Department of Cardiology, Türkiye Yüksek İhtisas Education & Research Hospital, Ankara, Turkey
| | - Duran Tok
- Department of Infectious diseases, Gülhane Military Medical Faculty, Ankara, Turkey
| | - Kumral Çağlı
- Department of Cardiology, Türkiye Yüksek İhtisas Education & Research Hospital, Ankara, Turkey
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Park SH, Rha SW, Choi BG, Park JY, Jeon U, Seo HS, Kim EJ, Na JO, Choi CU, Kim JW, Lim HE, Park CG, Oh DJ. Impact of high lipoprotein(a) levels on in-stent restenosis and long-term clinical outcomes of angina pectoris patients undergoing percutaneous coronary intervention with drug-eluting stents in Asian population. Clin Exp Pharmacol Physiol 2016; 42:588-95. [PMID: 25865336 DOI: 10.1111/1440-1681.12396] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 02/22/2015] [Accepted: 03/28/2015] [Indexed: 11/29/2022]
Abstract
Lipoprotein(a) (Lp(a)) is known to be associated with cardiovascular complications and atherothrombotic properties in general populations. However, it has not been examined whether Lp(a) levels are able to predict adverse cardiovascular outcomes in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES). A total of 595 consecutive patients with angina pectoris who underwent elective PCI with DES were enrolled from 2004 to 2010. The patients were divided into two groups according to the levels of Lp(a): Lp(a) < 50 mg/dL (n = 485 patients), and Lp(a) ≥ 50 mg/dL (n = 111 patients). The 6-9-month angiographic outcomes and 3-year cumulative major clinical outcomes were compared between the two groups. Binary restenosis occurred in 26 of 133 lesions (19.8%) in the high Lp(a) group and 43 of 550 lesions (7.9%) in the low Lp(a) group (P = 0.001). In multivariate analysis, the reference vessel diameter, low density lipoprotein cholesterol, total lesion length, and Lp(a) ≥ 50 mg/dL were predictors of binary restenosis. In the Cox proportional hazards regression analysis, Lp(a) > 50 mg/dL was significantly associated with the 3-year adverse clinical outcomes including any myocardial infarction, revascularization (target lesion revascularization (TLR) and target vessel revascularization (TVR)), TLR-major adverse cardiac events (MACEs), TVR-MACE, and All-MACEs. In our study, high Lp(a) level ≥ 50 mg/dL in angina pectoris patients undergoing elective PCI with DES was significantly associated with binary restenosis and 3-year adverse clinical outcomes in an Asian population.
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Affiliation(s)
- Sang-Ho Park
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University, Cheonan Hospital, Cheonan, Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University, Guro Hospital, Seoul, Korea
| | - Byoung-Geol Choi
- Cardiovascular Center, Korea University, Guro Hospital, Seoul, Korea
| | - Ji-Young Park
- Division of Cardiology, Department of Internal Medicine, Eulji Medical University, Seoul, Korea
| | - Ung Jeon
- Division of Cardiology, Department of Internal Medicine, Soonchunhyang University, Cheonan Hospital, Cheonan, Korea
| | - Hong-Seog Seo
- Cardiovascular Center, Korea University, Guro Hospital, Seoul, Korea
| | - Eung-Ju Kim
- Cardiovascular Center, Korea University, Guro Hospital, Seoul, Korea
| | - Jin-Oh Na
- Cardiovascular Center, Korea University, Guro Hospital, Seoul, Korea
| | - Cheol-Ung Choi
- Cardiovascular Center, Korea University, Guro Hospital, Seoul, Korea
| | - Jin-Won Kim
- Cardiovascular Center, Korea University, Guro Hospital, Seoul, Korea
| | - Hong-Euy Lim
- Cardiovascular Center, Korea University, Guro Hospital, Seoul, Korea
| | - Chang-Gyu Park
- Cardiovascular Center, Korea University, Guro Hospital, Seoul, Korea
| | - Dong-Joo Oh
- Cardiovascular Center, Korea University, Guro Hospital, Seoul, Korea
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Hu RT, Liu J, Zhou Y, Hu BL. Association of smoking with restenosis and major adverse cardiac events after coronary stenting: A meta-analysis. Pak J Med Sci 2015; 31:1002-8. [PMID: 26430448 PMCID: PMC4590384 DOI: 10.12669/pjms.314.7495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background and Objective: The association between smoking and clinical outcomes after coronary stenting is controversial. The aim of this meta-analysis was to assess the association between smoking and in stent restenosis (ISR), major adverse cardiac events (MACE), or major adverse cardiac and cerebrovascular events (MACCE) after coronary stenting. Methods: A search for studies published before December 2014 was conducted in PubMed, Embase, and Cochrane library. An inverse random weighted meta-analysis was conducted using logarithm of the odds ratio (OR) and its standard error for each study. Results: Ten studies investigated the association between smoking and ISR. Overall, smoking was not associated with ISR (OR: 1.05, 95% CI: 0.79–1.41; I2 = 47.8%). Subgroup analysis also failed to show a significant association between smoking and ISR risk regardless of bare metal stent (BMS) and drug-eluting stent (DES) implantation. Eight studies explored the association between smoking and MACE, but no association was found (OR: 0.92, 95% CI: 0.77–1.10; I2 = 25.5%), and subgroup analysis revealed that no distinct difference was found between BMS and DES implantation. Three studies investigated the association between smoking and MACCE and significant association was found (OR: 2.09, 95% CI: 1.43–3.06; I2 = 21.6%). Conclusions: Our results suggest that in patients undergoing percutaneous coronary intervention with stent implantation, smoking is not associated with ISR and MACE; however, smoking is an independent risk factor for MACCE.
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Affiliation(s)
- Rui-Ting Hu
- Rui-ting Hu, MD. Minzu Affiliated Hospital of Guangxi Medical University, 530001 Nanning, China
| | - Jie Liu
- Jie Liu, MD, PhD. Department of Cardiology, People's Hospital of Guangxi Zhuang Autonomous Region, 530021 Nanning, China
| | - You Zhou
- You Zhou, MD, PhD. Minerva Foundation Institute for Medical Research; FI-00290 Helsinki, Finland
| | - Bang-Li Hu
- Bang-li Hu, MD. First Affiliated Hospital of Guangxi Medical University, 530021 Nanning, China
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Pleva L, Kusnierova P, Plevova P, Zapletalova J, Karpisek M, Faldynova L, Kovarova P, Kukla P. Increased levels of MMP-3, MMP-9 and MPO represent predictors of in-stent restenosis, while increased levels of ADMA, LCAT, ApoE and ApoD predict bare metal stent patency. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2015; 159:586-94. [PMID: 26365933 DOI: 10.5507/bp.2015.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 07/14/2015] [Indexed: 11/23/2022] Open
Abstract
AIMS We sought to identify biochemical predictors that indicate susceptibility to in-stent restenosis (ISR) after coronary artery bare-metal stenting. METHODS A total of 111 consecutive patients with post-percutaneous coronary intervention (PCI) in-stent restenosis of a target lesion within 12 months were matched for age, sex, vessel diameter, and diabetes with 111 controls without post-PCI ISR. Plasma or serum levels of biochemical markers were measured: matrix metalloproteinases (MMP) 2, 3, 9; myeloperoxidase (MPO); asymmetric dimethylarginine (ADMA); lipoprotein (a) (Lp[a]); apolipoproteins E and D (ApoE and D); and lecitin-cholesterol acyltransferase (LCAT). Multivariable logistic regression association tests were performed. RESULTS Increased plasma MMP-3 (OR: 1.013; 95% CI: 1.004-1.023; P = 0.005), MMP-9 (OR: 1.014; 95% CI: 1.008-1.020; P < 0.0001) or MPO (OR: 1,003; 95% CI: 1.001-1.005; P = 0.002) was significantly associated with increased risk of ISR. Increased levels of ADMA (OR: 0.212; 95% CI: 0.054-0.827; P = 0.026), ApoE (OR: 0.924; 95% CI: 0.899-0.951; P < 0.0001), ApoD (OR: 0.919; 95% CI: 0.880-0.959; P = 0.0001), or LCAT (OR: 0.927; 95% CI: 0.902-0.952; P < 0.0001) was associated with risk reduction. No correlation was found between plasma MMP-2 or Lp (a) and ISR risk. CONCLUSIONS Increased levels of MMP-3, MMP-9, and MPO represent predictors of ISR after bare-metal stent implantation. In contrast, increased ADMA, LCAT, and Apo E and D indicate a decreased in-stent restenosis occurrence.
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Affiliation(s)
- Leos Pleva
- Department of Clinical Studies, Faculty of Medicine, University of Ostrava, Czech Republic.,Department of Cardiovascular Diseases, University Hospital Ostrava
| | - Pavlina Kusnierova
- Department of Biomedical Sciencies, Faculty of Medicine, University of Ostrava.,Department of Laboratory Medicine, University Hospital Ostrava
| | - Pavlina Plevova
- Department of Biomedical Sciencies, Faculty of Medicine, University of Ostrava.,Department of Medical Genetics, University Hospital Ostrava
| | - Jana Zapletalova
- Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc
| | | | - Lucie Faldynova
- Department of Biomedical Sciencies, Faculty of Medicine, University of Ostrava.,Department of Medical Genetics, University Hospital Ostrava
| | - Petra Kovarova
- Department of Biomedical Sciencies, Faculty of Medicine, University of Ostrava.,Blood Center, University Hospital of Ostrava
| | - Pavel Kukla
- Department of Cardiovascular Diseases, University Hospital Ostrava
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Association between baseline lipoprotein (a) levels and restenosis after coronary stenting: Meta-analysis of 9 cohort studies. Atherosclerosis 2013; 227:360-6. [DOI: 10.1016/j.atherosclerosis.2013.01.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 12/30/2012] [Accepted: 01/10/2013] [Indexed: 11/17/2022]
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Giovanetti F, Gargiulo M, Laghi L, D'Addato S, Maioli F, Muccini N, Borghi C, Stella A. Lipoprotein(a) and other serum lipid subfractions influencing primary patency after infrainguinal percutaneous transluminal angioplasty. J Endovasc Ther 2009; 16:389-96. [PMID: 19642794 DOI: 10.1583/09-2733.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the influence of serum lipid subfraction concentrations on arterial patency after percutaneous transluminal angioplasty (PTA) in patients with infrainguinal peripheral artery occlusive disease (PAOD). METHODS From January 2007 to June 2008, a prospective study was conducted involving 39 patients (29 men; mean age 68.6+/-10.0 years) with infrainguinal PAOD in 41 limbs who had preprocedural lipid assessment and underwent successful PTA (<30% residual stenosis). Patient demographics, Fontaine clinical stage classification, Texas University Classification of ulcers, coexisting medical conditions, endovascular procedures, and lipid profiles were collected in a database. Follow-up included clinical and duplex ultrasound evaluation at discharge and at 1, 3, 6, and 12 months. To analyze any correlation between various lipid subfractions and the loss of primary patency (Cox proportional hazards modeling), the patients were dichotomized into high and low groups according to these thresholds: LDL-C >100 mg/dL, HDL-C <40 mg/dL, Lp(a) >30 mg/dL, and an Apo(B)/Apo(A) ratio >0.8 mg/dL. RESULTS Mean follow-up was 7.5 months (range 3-12). After 1, 3, and 6 months, the primary patency rates by Kaplan-Meier analysis were 94.9%, 73.7%, and 64.1%, respectively. Restenosis at 6 months was significantly related to female gender (HR 95.9, 95% CI 6.8 to 1352.5, p = 0.001), HDL-C <40 mg/dL (HR 86.9, 95% CI 6.4 to 1183.1, p = 0.001), LDL-C >100 mg/dL (HR 9.6, 95% CI 1.6 to 57.4, p = 0.013), and Lp(a) >30 mg/dL (HR 6.1, 95% CI 1.4 to 26.3, p = 0.016). CONCLUSION Our results suggest that Lp(a), LDL-C, and HDL-C are independent risk factors for restenosis after infrainguinal PTA.
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Affiliation(s)
- Federica Giovanetti
- Department of Specialized Vascular Surgery and Anesthesiology, Alma Mater Studiorum, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
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Ashley EA, Ferrara R, King JY, Vailaya A, Kuchinsky A, He X, Byers B, Gerckens U, Oblin S, Tsalenko A, Soito A, Spin JM, Tabibiazar R, Connolly AJ, Simpson JB, Grube E, Quertermous T. Network analysis of human in-stent restenosis. Circulation 2006; 114:2644-54. [PMID: 17145989 DOI: 10.1161/circulationaha.106.637025] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent successes in the treatment of in-stent restenosis (ISR) by drug-eluting stents belie the challenges still faced in certain lesions and patient groups. We analyzed human coronary atheroma in de novo and restenotic disease to identify targets of therapy that might avoid these limitations. METHODS AND RESULTS We recruited 89 patients who underwent coronary atherectomy for de novo atherosclerosis (n=55) or in-stent restenosis (ISR) of a bare metal stent (n=34). Samples were fixed for histology, and gene expression was assessed with a dual-dye 22,000 oligonucleotide microarray. Histological analysis revealed significantly greater cellularity and significantly fewer inflammatory infiltrates and lipid pools in the ISR group. Gene ontology analysis demonstrated the prominence of cell proliferation programs in ISR and inflammation/immune programs in de novo restenosis. Network analysis, which combines semantic mining of the published literature with the expression signature of ISR, revealed gene expression modules suggested as candidates for selective inhibition of restenotic disease. Two modules are presented in more detail, the procollagen type 1 alpha2 gene and the ADAM17/tumor necrosis factor-alpha converting enzyme gene. We tested our contention that this method is capable of identifying successful targets of therapy by comparing mean significance scores for networks generated from subsets of the published literature containing the terms "sirolimus" or "paclitaxel." In addition, we generated 2 large networks with sirolimus and paclitaxel at their centers. Both analyses revealed higher mean values for sirolimus, suggesting that this agent has a broader suppressive action against ISR than paclitaxel. CONCLUSIONS Comprehensive histological and gene network analysis of human ISR reveals potential targets for directed abrogation of restenotic disease and recapitulates the results of clinical trials of existing agents.
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Affiliation(s)
- Euan A Ashley
- Division of Cardiovascular Medicine, Falk CVRC, Stanford University, Stanford, Calif 94305, USA.
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