Does the Inheritance of Lipoprotein(a) Cholesterol in Patients with Bypass Surgery Matter? (YES)

A large portion of the patients seen at the Kahn Center are interested in learning if they inherited the genetic capacity to produce Lipoprotein(a) or Lp(a) or "the sticky cholesterol". Others know they inherited it at a high level and seek guidance. As you know, I wrote a book on the topic.

Lp(a) is a causal risk factor for atherosclerosis of any artery in the body and also the aortic valve and related complications. The importance of Lp(a) inheritance in patients undergoing coronary artery bypass grafting remains unknown. A new study aimed to assess the impact of high Lp(a) on the long‐term prognosis of patients undergoing coronary artery bypass grafting.

STUDY

Consecutive patients with stable coronary artery disease who underwent isolated coronary artery bypass grafting from January 2013 to December 2018 from a single‐center were included. The primary outcome was all‐cause death. The secondary outcome was a composite of major adverse cardiovascular and cerebrovascular events.

Of the 18 544 patients, 4072 (22.0%) were identified as the high‐lipoprotein(a) group (≥50 mg/dL).

During a median follow‐up of 3.2 years, primary outcomes occurred in 587 patients. High lipoprotein(a) was associated with increased risk of all‐cause death (31% higher) and major adverse cardiovascular and cerebrovascular events (18% higher) and the higher the level of Lp(a), the higher the risk. The lipoprotein(a)‐related risk was greater in patients with saphenous vein bypass grafts versus arterial grafts like mammary artery bypasses

CONCLUSIONS

More than 1 in 5 patients with stable coronary artery disease who underwent coronary artery bypass grafting had elevated levels of Lp(a), which is associated with higher risks of death and major adverse cardiovascular and cerebrovascular events.

The adverse effects of lipoprotein(a) were more pronounced in patients not receiving arterial grafts.

The study group was Chinese but there is no reason to doubt these finds are universal. As lifestyle and statins do not lower levels of Lp(a), new agents currently under randomized blinded clinical study are badly needed and will hopefully improve the long-term outlook of all cardiac patients with elevated Lp(a). For now, we are often lowering Lp(a) significantly with protocols at the Kahn Center.

Author
Dr. Joel Kahn

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