Abstract
The detection of lipoprotein(a) [Lp(a)] in the artery wall at the stage of lipid-bands formation may indicate that it participates in the atherosclerosis local nonspecific inflammatory process. Innate immune cells are involved in atherogenesis, with monocytes playing a major role in the initiation of atherosclerosis, while neutrophils can contribute to plaque destabilization. This work studies the relationship between Lp(a), immune blood cells and major adverse cardiovascular events (MACE) in patients with the early manifestation of coronary heart disease (CHD). The study included 200 patients with chronic CHD, manifested up to the age of 55 in men and 60 in women. An increased Lp(a) concentration [hyperLp(a)] was shown to predict cardiovascular events in patients with premature CHD with long-term follow-up. According to the logistic regression analysis results, an increase in the monocyte count with OR = 4.58 (95% CI 1.04–20.06) or lymphocyte-to-monocyte ratio with OR = 0.82 (0.68–0.99), (p < 0.05 for both) was associated with MACE in patients with early CHD, regardless of gender, age, classical risk factors, atherogenic lipoproteins concentration and statin intake. The combination of an increased monocyte count and hyperLp(a) significantly increased the proportion of patients with early CHD with subsequent development of MACE (p = 0.02, p trend = 0.003). The odds of cardiovascular events in patients with early CHD manifestation were highest in patients with an elevated lymphocyte-to-monocyte ratio and an elevated Lp(a) level. A higher neutrophil blood count and an elevated neutrophil-to-lymphocyte ratio determined the faster development of MACE in patients with a high Lp(a) concentration. The data obtained in this study suggest that the high atherothrombogenicity of Lp(a) is associated with the “inflammatory” component and the innate immune cells involvement in this process. Thus, the easily calculated immunological ratios of blood cells and Lp(a) concentrations can be considered simple predictors of future cardiovascular events.
Highlights
Atherosclerotic cardiovascular diseases (ASCVDs) have remained the leading cause of death worldwide over the past 15 years, despite continued advances in pharmaceuticals and technology [1]
An elevated Lp(a) concentration was shown to be a predictor of cardiovascular events in patients with premature coronary heart disease (CHD) with long-term follow-up
The likelihood of cardiovascular events in patients with early CHD manifestation were highest in patients with an elevated lymphocyte-to-monocyte ratio and an elevated Lp(a) level
Summary
Atherosclerotic cardiovascular diseases (ASCVDs) have remained the leading cause of death worldwide over the past 15 years, despite continued advances in pharmaceuticals and technology [1]. Signs of the local nonspecific inflammatory process in atherosclerosis are traced from the earliest stages of the vessel-wall-lesion development to the stage of destabilization and atherosclerotic plaque damage [8,9]. The results of some studies have shown that enhanced myelopoiesis plays a central role in increasing monocyte and neutrophil numbers in cardiovascular disease and intensifies the formation of atherosclerotic lesions [11]. Residual cardiovascular risk in patients with atherosclerosis, despite adequate hypolipidemic therapy, could be related to the increased concentration of Lp(a) and, the possible relationship between Lp(a) and the vascular wall inflammation deserves further evaluation. The aim of this study is to investigate the association between Lp(a) concentration, immune blood cells count, and cardiovascular outcomes in patients with early manifestation of coronary heart disease (CHD)
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