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Lipoprotein(a) and Cardiovascular Outcomes in Patients with Coronary Artery Disease and Impaired glucose metabolism
Session:
Posters (Sessão 1 - Écran 6) - DAC e Cuidados Intensivos 1 - Síndromes Coronários Crónicos
Speaker:
Ana Débora Câmara de Sá
Congress:
CPC 2022
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.2 Coronary Artery Disease – Epidemiology, Prognosis, Outcome
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Débora sá; Roberto Palma Dos Reis; Marina Santos; Margarida Temtem; Ana Célia Sousa; Eva Henriques; Mariana Rodrigues; Sónia Freitas; Sofia Borges; Ilídio Ornelas; António Drumond; Maria Isabel Mendonça
Abstract
<p style="text-align:justify"><span style="color:#000000"><span style="font-family:Calibri"><span style="font-size:medium">Lipoprotein(a) [Lp(a)] is an LDL-like molecule composed of a part of apolipoprotein(a) bounding covalently to apolipoprotein B-100. High plasma Lp(a) levels were associated with MACE in stable CAD patients. Recent research shows contradictory results in stable CAD patients with high Lp(a) plasmatic levels and impaired glucose metabolism in MACE occurrence.</span></span></span></p> <p style="text-align:justify"><span style="background-color:white"><span style="font-family:Calibri"><span style="font-size:medium"><span style="color:#000000">A<strong>im:</strong></span><strong> </strong> </span></span></span></p> <p style="text-align:justify"><span style="background-color:white"><span style="color:#212121"><span style="font-family:Calibri"><span style="font-size:medium">Investigate whether high Lp(a) levels were associated with MACE in CAD patients with impaired glucose metabolism, at an extended follow-up.</span></span></span></span></p> <p style="text-align:justify"><span style="background-color:white"><strong><span style="color:#212121"><span style="font-family:Calibri"><span style="font-size:medium">Methods:</span></span></span></strong></span></p> <p style="text-align:justify"><span style="background-color:white"><span style="font-family:Calibri"><span style="font-size:medium"><span style="color:#212121">A prospective cohort of 1,127 CAD patients with impaired glucose metabolism (pre-diabetes and diabetes) was observed during </span><span style="color:black">4.9±3.4 years (range 1 to 17 years).</span><span style="color:#000000"> Pre-diabetes was considered when fasting plasma glucose ranged from 5.6 to 6.9 mmol/L, or hemoglobin A1c levels ranging from 5.7 to 6.4%. We consider high Lp(a) when values ≥30 mg/dL. Bivariate and multivariate analysis evaluated the risk of Lp(a)≥30 mg/dL for MACE occurrence. Kaplan-Meier curves estimated the survival probability for low and high Lp(a) levels.</span></span></span></span></p> <p style="text-align:justify"><span style="background-color:white"><strong><span style="color:#000000"><span style="font-family:Calibri"><span style="font-size:medium">Results:</span></span></span></strong></span></p> <p style="text-align:justify"><span style="background-color:white"><span style="font-family:Calibri"><span style="color:#000000"><span style="font-size:medium">Of the patients with Lp(a) levels > 30 44.4% presented MACE and 32.0% presented no MACE (p<0.0001). Cox regression analysis with smoking, hypertension, dyslipidemia, physical inactivity and kidney failure (creatinine clearance <60</span><span style="font-size:12pt"> mL/min</span><span style="font-size:medium">) showed that high Lp(a) remained in the equation as an independent risk factor for MACE (HR=1.24; p=0.031). The Kaplan-Meier showed better survival in the group with lower Lp(a) levels (p=0.023). </span></span></span></span></p> <p style="text-align:justify"><span style="background-color:white"><strong><span style="color:#000000"><span style="font-family:Calibri"><span style="font-size:medium">Conclusion:</span></span></span></strong></span></p> <p style="text-align:justify"><span style="color:#000000"><span style="font-family:Calibri"><span style="font-size:medium">Our study demonstrated that high Lp(a) levels were an independent predictor for MACE and for cardiovascular mortality in a CAD population with impaired glucose metabolism. This result suggests that Lp(a) measurement may help further risk stratification for diabetes and pre-diabetes patients suffering CAD. With the recent development of drugs that selectively lower Lp(a) levels, this marker can become a clinical target for reducing CVD risk.</span></span></span></p>
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