Lipoprotein(a) and SYNTAX Score Association with Severity of Coronary Artery Atherosclerosis in North India

Lipoprotein (a) and myocardial infarction: impact on long-term mortality

BACKGROUND AND AIMS

Lipoprotein (a) [Lp(a)] is a genetically regulated lipoprotein particle that is an independent risk factor for coronary atherosclerotic heart disease. However, the correlation between Lp(a) and left ventricular ejection fraction (LVEF) in patients with myocardial infarction (MI) has been poorly studied. The present study investigated the correlation between Lp(a) and LVEF, as well as the impact of Lp(a) on long-term mortality in patients with MI.

METHODS

Patients who underwent coronary angiography resulting in MI diagnosis between May 2018 and March 2020 at the First Affiliated Hospital of Anhui Medical University were included in this study. The patients were divided into groups based on the Lp(a) concentration and LVEF (reduced ejection fraction group: < 50%; normal ejection fraction group: ≥ 50%). Then, correlations between the Lp(a) level and LVEF, as well as the impact of Lp(a) on mortality, were assessed.

RESULTS

This study included 436 patients with MI. The Lp(a) level and LVEF were significantly and negatively correlated (r = -0.407, β = -0.349, P < 0.001). The area under the receiver operating characteristic curve (ROC) indicated that an Lp(a) concentration > 455 mg/L was the best predictive value for reduced ejection fraction (AUC: 0.7694, P < 0.0001). The clinical endpoints did not differ based on the Lp(a) concentration. However, all-cause mortality and cardiac mortality differed based on LVEF.

CONCLUSIONS

These results suggest that an elevated Lp(a) concentration predicts reduced ejection fraction and that LVEF predicts all-cause mortality and cardiac mortality in patients with MI.

Predictive value of the SYNTAX score for diabetic retinopathy in stable coronary artery disease patients with a concomitant type 2 diabetes mellitus

AIMS

Diabetic retinopathy (DR) is a serious complication of type 2 diabetes mellitus (T2DM) and is the most common cause of impaired vision for adults. DR is related to a number of risk factors. The aim of this study was to investigate the relationship between burden of coronary artery disease assessed by Syntax Score (SS) and DR in T2DM.

METHODS

A total of 96 T2DM patients undergoing coronary angiography were prospectively included in the study. Presence and severity of DR were assessed by ocular fundus examination. DR was graded as no apparent retinopathy (NDR), non-proliferative (NPDR), and proliferative DR (PDR). The SS for each patient was calculated.

RESULTS

The mean age was 58.0 ± 8.2 years. SS gradually increased from NDR group to PDR group. The median (IQR) value of SS was 10 (5-16) in patients with NDR, 22.8 (17-35.8) in those with NPDR, and 35.5 (28-37) in those with PDR (p < 0.001). On multivariate analysis SS [odds ratio (OR) 1.145, p = 0.001] and duration of diabetes (OR 1.753, p = 0.031) were independent factors for DR.

CONCLUSIONS

The SS is independently associated with the occurrence of DR in T2DM. Ophthalmologists and cardiologists must cooperate when evaluating patients with DM because of possible complications.

Elevated Lipoprotein A in South Asians and the Associated Risk of Cardiovascular Disease: A Systematic Review

BACKGROUND

South Asians have a premature risk of cardiovascular disease and increased lipoprotein A which enhances their risk.

METHODS

This systematic review evaluates the role of elevated lipoprotein A in cardiovascular disease risk for South Asians. It discusses the pathophysiology, clinical studies, and treatment of elevated lipoprotein A using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method.

RESULTS

A total of 72 articles was incorporated which consisted of clinical studies, case-control and cohort studies, meta-analysis, reviews, and editorials. Cardiovascular disease and myocardial infarction occurs prematurely in South Asians, which is further enhanced with an elevated lipoprotein A.

CONCLUSIONS

South Asians with an elevated lipoprotein A have an increased risk of coronary artery disease so they should have early enactment of lifestyle modification and aggressive medical management.

The Association of Syntax Score with Levels of Lipoprotein(a) and Inflammatory Biomarkers in Patients with Stable Coronary Artery Disease and Different Low-Density Lipoprotein Cholesterol Levels

INTRODUCTION

Lipoprotein(a) (Lp(a)) is associated with the severity of coronary lesions evaluated using Syntax score in patients with stable coronary artery disease (CAD). However, the effect of low-density lipoprotein cholesterol (LDL-C) levels on the association of Lp(a) levels with Syntax score remains unclear.

METHODS

A total of 646 patients with stable CAD were enrolled in the present study. Lp(a) levels were measured with an AU5800 Chemistry Analyzer. Syntax scores were calculated by two advanced interventional cardiologists. SPSS 22.0 was used for statistical analyses.

RESULTS

The concentration of Lp(a) ranged from 1 to 192 mg/dL. Pearson's correlation analysis showed a positive correlation between Syntax score and the level of Lp(a) (r = 0.108, p = 0.006). The LDL-C ≥100 mg/dL group presented with a higher Lp(a) level, 16 (9-29) vs 13 (7-24). Pearson's correlation analysis identified a correlation between Lp(a) level and Syntax score (r = 0.249, p < 0.001) only in the LDL-C ≥100 mg/dL group. Multivariate logistic regression analysis revealed the positive predictive value of an Lp(a) level >30 mg/dL for a Syntax score ≥23 only in the LDL-C ≥100 mg/dL group, adjusted odds ratio 2.895, p = 0.010. A receiver operating characteristic curve analysis confirmed the predictive value of Lp(a) levels for a Syntax score ≥23 in the LDL-C ≥100 mg/dL group with a cutoff value for Lp(a) >30 mg/dL.

DISCUSSION

The association between Lp(a) level and Syntax score was only maintained in the LDL-C ≥100 mg/dL group. An Lp(a) level >30 mg/dL was an independent predictor of a Syntax score ≥23 only in the LDL-C ≥100 mg/dL group. The effect of LDL-C levels on the association of Lp(a) levels with Syntax score requires further investigations.

Plasma Lipoprotein(a) Concentration Is Associated With the Coronary Severity but Not With Events in Stable Coronary Artery Disease Patients: A Chinese Cohort Study

BACKGROUND

Although lipoprotein(a) (Lp(a)) has been regarded as an independent risk factor for atherosclerotic cardiovascular disease (ASCVD), its predictive role in outcomes in stable coronary artery disease (CAD) has been undetermined. The aim of the present study was to investigate the relations of Lp(a) to the coronary severity and events in Chinese patients with angiography-proven stable CAD.

METHODS

A total of 3,278 patients with stable CAD were consecutively enrolled and the coronary severity was evaluated by the Gensini Score (GS) system. Patients were divided into two groups according to the median of GS: high GS group (n=1,585) and low GS group (n=1,693). The associations of continuous Lp(a), Lp(a) ≥300mg/L, and tertiles of Lp(a) with GS and events were respectively evaluated.

RESULTS

Patients in the high GS group had significantly higher concentrations of Lp(a). In addition, the multivariate Cox regression analysis indicated that elevated Lp(a) (odds ratio: 1.164, 95% confidence interval: 1.005-1.349), Lp(a) ≥300mg/L (odds ratio: 1.200, 95% confidence interval: 1.028-1.401), and the highest tertile of Lp(a) (odds ratio: 1.205, 95% confidence interval: 1.010-1.438) were statistically associated with GS after adjusted for potential confounders. However, although 215 (6.56%) events were established during a median of follow-up over 10,170 patient-years, no relationship between Lp(a) and events was found.

CONCLUSIONS

In this Chinese cohort study on stable CAD with moderate sample size and follow-up duration, data showed that Lp(a) was significantly associated with the coronary severity while not with cardiovascular events, similar to several studies, suggesting that further study is needed regarding the role of Lp(a) in ASCVD.

Circulating Thrombotic Risk Factors in Young Patients with Coronary Artery Disease Who Are on Statins and Anti-platelet Drugs

Thrombotic risk factors may contribute to premature coronary artery disease (CAD), in addition to the conventional risk factors. There is paucity of data on studies evaluating the role of thrombotic factors in premature CAD in Indian patients. Thus a case-control study was performed to evaluate the role of thrombotic and atherogenic factors in young patients with angiographically proven CAD who are on treatment with statins and anti-platelet drugs. 152 patients (≤55 years) with angiographically proven CAD and 102 asymptomatic controls were recruited. Clinical and biochemical data were obtained in both groups. Blood levels of thrombotic factors-fibrinogen, antithrombin-III, tissue-plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), von-Willebrand factor (v-WF), lipoprotein(a) [Lp(a)] and homocysteine were analyzed. Patients had high levels of conventional CAD risk factors (diabetes mellitus, smoking, hypertension, dyslipidemia and positive family history) compared to controls. Logistic regression analysis revealed that low antithrombin-III (odds ratio/OR 11.2; 95 % confidence interval/CI 2.29-54.01), high fibrinogen (OR 6.04; 95 % CI 1.09-33.21) and high Lp(a) (OR 4.54; 95 % CI 0.92-22.56), as important, independent risk factors in patients. PAI-1(OR 0.15; 95 % CI 0.03-0.69) levels were significantly lower in patients. But other thrombotic risk factors studied (t-PA, v-WF and homocysteine) were comparable among patients and controls. The treatment using statins and anti-platelet drugs might be contributing to the control of some of the thrombotic risk factors. The strategies aiming at lowering the levels of thrombotic risk factors along with conventional risk factors may be useful in primary and secondary prevention of CAD.

Risk Stratification for Percutaneous Coronary Intervention

The Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score is a semiquantitative angiographic score developed to prospectively characterize the disease complexity of the coronary vasculature. With more than 50 validation studies, the SYNTAX score is the most-studied risk model in the setting of percutaneous coronary intervention. In this article, the evolutionary journey of the SYNTAX score is reviewed, with emphasis on its sequential modifications and adaptations, now culminating in the development and validation of the SYNTAX score II.

Expression of vascular cell adhesion molecule-1 in the aortic tissues of atherosclerotic patients and the associated clinical implications

The aim of this study was to investigate the expression level of vascular cell adhesion molecule-1 (VCAM-1) in the aortic tissues of atherosclerotic patients and to explore the associated clinical implications. Full-thickness aortic wall tissue samples were collected from atherosclerotic patients. Biochemical analysis was used for the detection of the serum levels of triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), lipoprotein (a) [Lp (a)], apolipoprotein (Apo) AI and Apo-B. Coronary angiography and SYNTAX scoring were used to determine the extent and severity of the disease. Immunohistochemistry was employed for the detection of the VCAM-1 protein expression levels in the arterial tissues. Significant differences were observed in the blood lipid levels between atherosclerotic patients and control subjects. Immunohistochemistry indicated that the aortic VCAM-1 expression level in atherosclerotic patients was 0.23±0.06 optical density (OD) units, which was significantly higher than that in the control subjects (0.08±0.03 OD units). In the atherosclerotic patients, the aortic VCAM-1 expression was positively correlated with the serum levels of TG (r=0.347), TC (r=0.469), LDL-C (r=0.463), Lp (a) (r=0.507) and Apo-B (r=0.384), while VCAM-1 and HDL-C were negatively correlated (r=-0.319). Furthermore, a higher SYNTAX score was accompanied by a higher VCAM-1 expression level (r=0.532), and an elevated aortic VCAM-1 expression was associated with certain cardiovascular risk factors. In conclusion, aortic VCAM-1 expression is associated with the severity of atherosclerosis and cardiovascular risk factors, indicating that VCAM-1 plays a role in the pathogenesis of atherosclerosis.