Raised lipoprotein(a) concentrations are considered to be a risk factor for atherothrombotic diseases. We examined whether baseline concentrations were a risk factor for an adverse outcome in patients admitted with acute coronary syndromes.
Methods and Results
Five hundred and nineteen patients admitted with suspected acute coronary syndromes were studied and followed prospectively for a median of 3 years. The prognostic significance of a baseline lipoprotein(a) concentration of ≥30mg.dl−1or lower for subsequent cardiac death was assessed in patients with myocardial infarction (266) and unstable angina (197) and compared with other variables in regression models. In patients with myocardial infarction, a baseline lipoprotein(a) concentration of ≥30mg.dl−1was associated with a 62% increase in subsequent cardiac death compared to the lower concentration group (29·8% vs 18·6%, Log rankP=0·04). In a multivariate regression model a baseline lipoprotein(a) concentration of ≥30mg.dl−1retained its significance as an independent predictor of cardiac death (P=0·037). In patients with unstable angina, baseline concentrations of ≥7·9mg.dl−1were found to be significant predictors of cardiac death in univariate (P=0·021) and multivariate (P=0·035) regression models.
Baseline lipoprotein(a) concentrations in patients admitted with acute coronary syndromes are associated with an increased risk of cardiac death. For patients with myocardial infarction a concentration of ≥30mg.dl−1appears appropriate as a risk discriminator; for patients admitted with unstable angina, however, much lower concentrations of lipoprotein(a) appear to be prognostically important.
The study was supported in part by a grant awarded to P. Stubbs from the Coronary Thrombosis Trust.
Correspondence: Dr Peter John Stubbs, Department of Cardiology, Royal Free Hospital, Pond Street, Hampstead, London NW3, U.K.
Professor Mark Noble is the Garfield Weston Professor of Cardiovascular Medicine.