Abstract
Background: Angina that is refractory to conventional medical therapy and revascularisation, remains challenging to manage and poses significant burden to patients. Elevated lipoprotein(a) [Lp(a)] has emerged as an important independent cardiovascular risk factor and predictor of adverse outcomes in atherosclerotic disease. The prevalence of raised Lp(a) amongst patients with refractory angina has not yet been defined. Objective: To establish the prevalence of raised [Lp(a)] >500 mg/L in patients with refractory angina. Methods: We conducted an epidemiological screening pilot study in 75 patients with refractory angina from a UK tertiary cardiac centre. We determined the proportion of the cohort with raised Lp(a) >500 mg/L using an isoform-insensitive method. In addition, a full fasting lipid profile (including: LDL cholesterol, HDL cholesterol, total cholesterol to HDL ratio and triglycerides) was obtained. Patients were also asked about the presence of conventional cardiovascular risk factors. Results: Our study demonstrated that 60% of the 75 patients with refractory angina had raised Lp(a) levels of >500 mg/L. The median and inter-quartile range of Lp(a) values were 771 mg/L (162 mg/L,1260 mg/L) respectively. Conclusions: This high prevalence of raised Lp(a) detected in our cohort with refractory angina may suggest a causal role. Further research is necessary to confirm this association and prospective studies are needed to explore the potential therapeutic benefit of Lp(a) reduction in patients with refractory angina.
Highlights
Cardiovascular disease remains the leading cause of death in the developed world
Further research is necessary to confirm this association and good quality prospective studies are urgently needed to explore the potential benefit of aggressive Lp(a) reduction in patients with refractory angina
There is a subset of patients who have severe disabling angina from coronary artery disease which is refractory to conventional therapy,[2] for whom management is challenging
Summary
Cardiovascular disease remains the leading cause of death in the developed world. The majority of patients with angina, resulting from coronary heart disease (CHD) are successfully treated with conventional medical therapy and revascularisation techniques such as coronary artery bypass graft (CABG) surgery or percutaneous coronary interventions (PCI).[1]. Refractory angina, as defined by Mannheimer and colleagues in 2002, is ‘a chronic condition characterised by the presence of angina caused by coronary insufficiency in the presence of coronary artery disease which cannot be controlled by a combination of medical therapy, angioplasty and coronary bypass surgery’.2. Angina that is refractory to conventional medical therapy and revascularisation, remains challenging to manage and poses significant burden to patients. The prevalence of raised Lp(a) amongst patients with refractory angina has not yet been defined. Methods: We conducted an epidemiological screening pilot study in 75 patients with refractory angina from a UK tertiary cardiac centre. Results: Our study demonstrated that 60% of the 75 patients with refractory angina had raised Lp(a) levels of . Conclusions: This high prevalence of raised Lp(a) detected in our cohort with refractory angina may suggest a causal role. Further research is necessary to confirm this association and prospective studies are needed to explore the potential therapeutic benefit of Lp(a) reduction in patients with refractory angina
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