Department of Vascular Surgery, University Medical Center Utrecht, PO Box 85500, 3508, GA, Utrecht, the Netherlands.
Department of Vascular Surgery, University Medical Center Utrecht, PO Box 85500, 3508, GA, Utrecht, the Netherlands; Netherlands Heart Institute, Moreelsepark 1, 3511, EP, Utrecht, the Netherlands; Department of Cardiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105, AZ, the Netherlands.
Atherosclerosis. 2022 May;349:196-203. doi: 10.1016/j.atherosclerosis.2021.11.019. Epub 2021 Nov 24.
Elevated lipoprotein(a) (Lp[a]) has been identified as a causal risk factor for cardiovascular disease including peripheral arterial disease (PAD). Although Lp(a) is associated with the diagnosis of PAD, it remains elusive whether there is an association of Lp(a) with cardiovascular and limb events in patients with severe PAD.
Preoperative plasma Lp(a) levels were measured in 384 consecutive patients that underwent iliofemoral endarterectomy and were included in the Athero-Express biobank. Our primary objective was to assess the association of Lp(a) levels with Major Adverse Limb Events (MALE). Our secondary objective was to relate Lp(a) levels to Major Adverse Cardiovascular Events (MACE) and femoral plaque composition that was acquired from baseline surgery.
During a median follow-up time of 5.6 years, a total of 225 MALE were recorded in 132 patients. Multivariable analysis, including history of peripheral intervention, age, diabetes mellitus, end stage renal disease and PAD disease stages, showed that Lp(a) was independently associated with first (HR of 1.36 (95% CI 1.02-1.82) p = .036) and recurrent MALE (HR 1.36 (95% CI 1.10-1.67) p = .004). A total of 99 MACE were recorded but Lp(a) levels were not associated with MACE.sLp(a) levels were significantly associated with a higher presence of smooth muscle cells in the femoral plaque, although this was not associated with MALE or MACE.
Plasma Lp(a) is independently associated with first and consecutive MALE after iliofemoral endarterectomy. Hence, in patients who undergo iliofemoral endarterectomy, Lp(a) could be considered as a biomarker to enhance risk stratification for future MALE.
脂蛋白(a)（Lp[a]）升高已被确定为心血管疾病（包括外周动脉疾病（PAD））的致病危险因素。尽管 Lp(a)与 PAD 的诊断有关，但在严重 PAD 患者中，Lp(a)与心血管和肢体事件的关联仍不清楚。
在 384 例连续接受髂股动脉内膜切除术的患者中测量了术前血浆 Lp(a)水平，并将其纳入 Athero-Express 生物库。我们的主要目的是评估 Lp(a)水平与主要不良肢体事件（MALE）的关系。我们的次要目的是将 Lp(a)水平与主要不良心血管事件（MACE）和从基线手术获得的股动脉斑块成分相关联。
在中位数为 5.6 年的随访期间，在 132 例患者中记录了总共 225 例 MALE。多变量分析包括外周介入史、年龄、糖尿病、终末期肾病和 PAD 疾病分期，表明 Lp(a)与首次（HR 1.36（95%CI 1.02-1.82）p=0.036）和复发性 MALE（HR 1.36（95%CI 1.10-1.67）p=0.004）独立相关。共记录了 99 例 MACE，但 Lp(a)水平与 MACE 无关。sLp(a)水平与股动脉斑块中平滑肌细胞的存在显著相关，尽管这与 MALE 或 MACE 无关。
血浆 Lp(a)与髂股动脉内膜切除术后首次和连续 MALE 独立相关。因此，在接受髂股动脉内膜切除术的患者中，Lp(a)可被视为预测未来 MALE 的生物标志物。
