Available online 13 October 2022

The predictive capability of Lp(a) for cardiovascular mortality was evaluated over a long-term follow-up period in two cohorts (total n = 1222) of symptomatic PAD with high rates of secondary prevention medication.

Lp(a) was not associated with cardiovascular mortality in both cohorts.

No specific pattern of lesion site (iliacal, femoral, below the knee, multivessel) for endovascular repair was detected with elevated Lp(a) levels.

This data suggests that elevated Lp(a) does not impose an additional risk to patients with PAD after endovascular repair and with high rates of statin treatment.

Despite low LDL-C goals, the residual risk for further cardiovascular (CV) events in patients with peripheral artery disease (PAD) remains high. Lipoprotein (a) (Lp(a)) is a known risk factor for PAD incidence, but little is known regarding the outcome in patients with symptomatic PAD. Thus, this study investigates Lp(a) and CV mortality in PAD after endovascular repair.

A total of 1222 patients with PAD in two cohorts according to Lp(a) assay in nmol/L (n = 964, Lip-LEAD-A) or mg/dl (n = 258, Lip-LEAD-B) were followed up for 4.3 (IQR 3.0–5.6) or 7.6 (IQR 3.2–8.1) years. Lp(a) was measured before endovascular repair for either intermittent claudication (IC) or critical limb ischemia (CLI). Outcome information was obtained from the federal death registry.

In Lip-LEAD-A, 141 CV-deaths occurred (annual calculated CV-death rate 3.4), whereas 64 CV-deaths were registered in Lip-LEAD-B (annual calculated CV-death rate 3.3). After adjustment for traditional CV risk factors Lp(a) was neither associated with outcome in Lip-LEAD-A (highest tertile HR 1.47, 95%CI [0.96–2.24]) nor in Lip-LEAD-B (highest tertile HR 1.34 [0.70–2.58]). Subanalyses for IC (HR 1.37 [0.74–2.55]; HR 1.10 [0.44–2.80], CLI (HR 1.55 [0.86–2.80], HR 3.01 [0.99–9.10]), or concomitant coronary artery disease (CAD; HR 1.34 [0.71–2.54]; HR 1.21 [0.46–3.17]) failed to show a significant association between Lp(a) and CV-mortality.

In this large-scale cohort of symptomatic PAD no association of elevated Lp(a) with CV mortality was found over a median observation period of 5 years. Thus, an even longer study including asymptomatic patients is warranted.

Peripheral artery disease

Atherosclerosis

lipids

Outcome

Lipoprotein (a)

© 2022 The Authors. Published by Elsevier B.V.