Abstract 14774: Association Between Cumulative Lipoprotein(a) Exposure and Adverse Cardiovascular Outcomes in Patients With Prediabetes or Diabetes: Insights From an Asian Cohort Following Percutaneous Coronary Intervention

Abstract

Introduction: Lipoprotein(a) is a complex circulating lipoprotein and growing evidence has demonstrated its role as a risk factor for coronary artery diseases and as a promising therapeutic target. However, the impact of cumulative Lp(a) exposure on long-term cardiovascular prognosis remains indistinct. Hypothesis: The aim of this study is to determine the impact of cumulative Lp(a) exposure [CumLp(a)] on long-term cardiovascular prognosis in patients with CAD and different glycemic metabolism status. Methods: We consecutively enrolled 10,724 patients with CAD hospitalized for PCI from January to December in 2013. Cumulative Lp(a) exposure was calculated as the area under the Lp(a) versus age trajectory. According to the optimal cut-off value of CumLp(a) for the major adverse cardiac and cerebrovascular events risk prediction and different glycemic metabolism status, patients were categorized into six groups. Results: 9,329 patients were ultimately enrolled in the current study. 2,073 MACCEs were documented during a median of 5 years’ follow-up. CumLp(a) was a significantly independent prognostic factor in the total population, in the Pre-DM groups and in the DM groups (HR: 1.45, 95% CI 1.12-1.89, P = 0.006; HR: 1.08, 95% CI 1.01-1.16, P = 0.018; HR: 1.07 95% CI 1.00-1.13, P = 0.037; respectively). Moreover, compared to ones with CumLp(a)-L and non-DM, patients with CumLp(a)-H and DM, CumLp(a)-H and Pre-DM, and CumLp(a)-L and DM had increased risk of 5-year MACCEs (HR: 1.50, 95% CI 1.21-1.87, P < 0.001; HR: 1.39 95% CI 1.11-1.73, P = 0.004; HR: 1.33, 95% CI 1.08-1.64, P = 0.008; respectively). Conclusions: In this real-world study, higher level of CumLp(a) combined with DM or Pre-DM was significantly related to worse 5-year cardiovascular outcomes among patients with CAD undergoing PCI, suggesting that evaluation of CumLp(a) and impaired glycemic metabolism status may help identify high-risk individuals who would benefit from further therapeutic interventions.