Elevated lipoprotein(a) levels increase risk of secondary major adverse cardiovascular events in patients undergoing carotid endarterectomy

2020 ◽  
Vol 315 ◽  
pp. e146
Author(s):  
F. Waissi ◽  
N. Timmerman ◽  
M. Dekker ◽  
R.M. Hoogeveen ◽  
J.G. Schnitzler ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Cardiovascular Events ◽  
Major Adverse Cardiovascular Events ◽  
Lipoprotein A ◽  
Increase Risk

scholarly journals Elevated Lp(a) (Lipoprotein[a]) Levels Increase Risk of 30-Day Major Adverse Cardiovascular Events in Patients Following Carotid Endarterectomy

Stroke ◽  
2020 ◽  
Vol 51 (10) ◽  
pp. 2972-2982 ◽  
Author(s):  
Farahnaz Waissi ◽  
Mirthe Dekker ◽  
Nathalie Timmerman ◽  
Renate M. Hoogeveen ◽  
Joelle van Bennekom ◽  
...  
Keyword(s):  
Risk Factor ◽  
Carotid Endarterectomy ◽  
Cardiovascular Events ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Major Adverse Cardiovascular Events ◽  
Lipoprotein A ◽  
Kaplan Meier ◽  
Increased Risk

Background and Purpose: General population studies have shown that elevated Lp(a) (lipoprotein[a]) levels are an emerging risk factor for cardiovascular disease and subsequent cardiovascular events. The role of Lp(a) for the risk of secondary MACE in patients undergoing carotid endarterectomy (CEA) is unknown. Our objective is to assess the association of elevated Lp(a) levels with the risk of secondary MACE in patients undergoing CEA. Methods: Lp(a) concentrations were determined in preoperative blood samples of 944 consecutive patients with CEA included in the Athero-Express Biobank Study. During 3-year follow-up, major adverse cardiovascular events (MACE), consisting of myocardial infarction, stroke, and cardiovascular death, were documented. Results: After 3 years follow-up, Kaplan-Meier cumulative event rates for MACE were 15.4% in patients with high Lp(a) levels (>137 nmol/L; >80th cohort percentile) and 10.2% in patients with low Lp(a) levels (≤137 nmol/L; ≤80th cohort percentile; log-rank test: P =0.047). Cox regression analyses adjusted for conventional cardiovascular risk factors revealed a significant association between high Lp(a) levels and 3-year MACE with an adjusted hazard ratio of 1.69 (95% CI, 1.07–2.66). One-third of MACE occurred within 30 days after CEA, with an adjusted hazard ratio for the 30-day risk of MACE of 2.05 (95% CI, 1.01–4.17). Kaplan-Meier curves from time point 30 days to 3 years onward revealed no significant association between high Lp(a) levels and MACE. Lp(a) levels were not associated with histological carotid plaque characteristics. Conclusions: High Lp(a) levels (>137 nmol/L; >80th cohort percentile) are associated with an increased risk of 30-day MACE after CEA. This identifies elevated Lp(a) levels as a new potential risk factor for secondary cardiovascular events in patients after carotid surgery. Future studies are required to investigate whether Lp(a) levels might be useful in guiding treatment algorithms for carotid intervention.

Serum levels of anti-apolipoprotein A-1 auto-antibodies and myeloperoxidase as predictors of major adverse cardiovascular events after carotid endarterectomy

2013 ◽  
Vol 109 (04) ◽  
pp. 706-715 ◽  
Author(s):  
Giovanni Spinella ◽  
Sabrina Pagano ◽  
Maria Bertolotto ◽  
Bianca Pane ◽  
Aldo Pende ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Cardiovascular Events ◽  
Predictive Accuracy ◽  
Positive Likelihood Ratio ◽  
Major Adverse Cardiovascular Events ◽  
Enzyme Linked Immunosorbent Assay ◽  
Operating Characteristics ◽  
Apolipoprotein A ◽  
One Year

SummaryWe aimed at challenging the prognostic accuracies of myeloperoxidase (MPO) and antibodies anti-apolipoprotein A-1 (anti-apoA-1 IgG), alone or in combination, for major adverse cardiovascular events (MACE) prediction, one year after carotid endarterectomy (CEA). In this prospective single centre study, 178 patients undergoing elective CEA were included. Serum anti-apoA-1 IgG and MPO were assessed by enzyme-linked immunosorbent assay prior to the surgery. Post-hoc determination of the MPO cut-off was performed by receiver operating characteristics (ROC) analyses. MACE was defined by the occurrence of fatal or non-fatal acute coronary syndromes or stroke during one year follow-up. Prognostic accuracy of anti-apoA-1 IgG was assessed by ROC curve analyses, survival analyses and reclassification statistics. During follow-up, 5% (9/178) of patients presented a MACE, and 29% (52/178) were positive for anti-apoA-1 IgG. Patients with MACE had higher median MPO and anti-apoA-1 IgG levels at admission (p=0.01), but no difference for the 10-year global Framingham risk score (FRS) was observed (p=0.22). ROC analyses indicated that both MPO and anti-apoA-1 IgG were significant predictors of subsequent MACE (area under the curve [AUC]: 0.75, 95% confidence interval [95%CI]: 0.61–0.89, p=0.01; and 0.74, 95%CI: 0.59–90; p=0.01), but combining anti-apoA-1 IgG positivity and MPO>857 ng/ml displayed the best predictive accuracy (AUC: 0.78, 95%CI: 0.65–0.91; p=0.007). It was associated with a poorer MACE-free survival (98.2% vs. 57.1%; p<0.001, LogRank), with a positive likelihood ratio of 13.67, and provided incremental predictive ability over FRS. In conclusion, combining the assessment of anti-apoA-1 IgG and MPO appears as a promising risk stratification tool in patients with severe carotid stenosis.

scholarly journals Glycophorin C in atherosclerotic plaque is associated with major adverse cardiovascular events after carotid endarterectomy.

2021 ◽  
Author(s):  
Joost M. Mekke ◽  
Tim R. Sakkers ◽  
Maarten C. Verwer ◽  
Noortje van den Dungen ◽  
Yipei Song ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Atherosclerotic Plaque ◽  
Cardiovascular Events ◽  
Neurological Symptoms ◽  
Intraplaque Hemorrhage ◽  
Major Adverse Cardiovascular Events ◽  
Symptomatic Carotid ◽  
Postoperative Risk ◽  
Male Patients ◽  
Glycophorin C

Introduction Histological assessment studies have identified the presence of intraplaque hemorrhage (IPH) as an indicator of plaque instability and resulting ischemic cerebral sequelae. Although the presence of IPH has been studied extensively in relation to neurological symptoms preceding carotid endarterectomy (CEA) or as a predictor for postoperative risk of major adverse cardiovascular events (MACE), the degree of IPH has not been studied before. Glycophorin, an erythrocyte-specific protein, has been suggested as a marker for the degree of previous hemorrhages in atherosclerotic plaque since erythrocytes are prominently present in IPH. We hypothesized that quantified plaque glycophorin C, as a proxy for the degree of IPH, is associated with destabilizing plaque characteristics, preprocedural symptoms, and increased postoperative risk for MACE. Methods We quantified glycophorin C and six other plaque characteristics with the slideToolkit method. We used human atherosclerotic plaque samples from 1971 consecutive asymptomatic and symptomatic (carotid endarterectomy) patients in the Athero-Express Biobank. Results The total area of glycophorin C in plaque was larger in individuals with a plaque with IPH compared to individuals with plaque without IPH (p<0.001). Quantified glycophorin C was significantly associated with ipsilateral pre-procedural neurological symptoms (OR:1.27, 95%CI:1.06-1.41, p=0.005). In addition, quantified glycophorin C was independently associated with an increased postoperative risk for MACE (HR:1.31, 95%CI:1.01-1.68, p=0.04). Stratified by sex, quantified glycophorin C was associated with an increased postoperative risk for MACE in male patients (HR:1.50, 95%CI:1.13-1.97, p=0.004), but not in female patients (HR:0.70, 95%CI:0.39-1.27, p=0.23). Conclusion Quantified glycophorin C, as a proxy for the degree of IPH, was independently associated with the presence of IPH, symptomatic preprocedural symptoms, and with an increased three-year postoperative risk of MACE. These findings indicate that quantified plaque glycophorin C can be considered as a marker for identifying male patients with a high residual risk for secondary MACE after CEA.

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