Diseases · 6 authors, 2 centres
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In a prospective study of 116 patients with premature coronary heart disease followed for a median of 14 years, a low-molecular-weight (LMW) apo(a) phenotype was an independent predictor of non-fatal myocardial infarction, but not for other cardiovascular events.
This prospective cohort study with retrospective data collection followed 116 patients with premature coronary heart disease (CHD) for a median of 14 years to evaluate predictors of new cardiovascular events. Patients were categorized by apo(a) phenotype into low-molecular-weight (LMW, n=52) and high-molecular-weight (HMW, n=64) groups. The study found that an LMW apo(a phenotype was an independent predictor for the development of non-fatal myocardial infarction (MI), with a hazard ratio of 2.29 (95% CI 1.08–4.81, p=0.03), after adjustment for sex, age of CHD debut, baseline lipids, and statin use. Elevated Lp(a) concentration (≥50 mg/dL) was associated with a 67% increased risk of overall cardiovascular events, but not independently for MI. The LMW phenotype was also associated with higher levels of the circulating PCSK9-Lp(a) complex. Limitations include the small sample size and the lack of initial PCSK9 and complex measurements to establish causality. The findings suggest the LMW apo(a) phenotype may be a key risk factor for MI in premature CHD, potentially mediated via PCSK9 interactions.
