High lipoprotein(a) is associated with major adverse limb events after femoral artery endarterectomy

• Published in: Atherosclerosis Vol. 349; pp. 196 - 203
• Main Authors: Verwer, Maarten C., Waissi, Farahnaz, Mekke, Joost M., Dekker, Mirthe, Stroes, Erik S.G., de Borst, Gert J., Kroon, Jeffrey, Hazenberg, Constantijn E.V.B., de Kleijn, Dominique P.V.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.05.2022
• Subjects: Critical limb ischemia; Critical limb-threatening ischemia; Endarterectomy - adverse effects; Femoral Artery - surgery; Humans; Iliac Artery - surgery; Lipoprotein(a); MALE; Morbidity; Outcome; Peripheral Arterial Disease - diagnosis; Peripheral Arterial Disease - surgery; Peripheral artery disease; Plaque, Atherosclerotic - etiology; Recurrent event; Risk Factors; Critical limb-threatening ischemia; Lipoprotein(a); Outcome; Recurrent event; Peripheral artery disease; Critical limb ischemia; Morbidity; MALE
• ISSN: 0021-9150; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2021.11.019

Elevated lipoprotein(a) (Lp[a]) has been identified as a causal risk factor for cardiovascular disease including peripheral arterial disease (PAD). Although Lp(a) is associated with the diagnosis of PAD, it remains elusive whether there is an association of Lp(a) with cardiovascular and limb events in patients with severe PAD. Preoperative plasma Lp(a) levels were measured in 384 consecutive patients that underwent iliofemoral endarterectomy and were included in the Athero-Express biobank. Our primary objective was to assess the association of Lp(a) levels with Major Adverse Limb Events (MALE). Our secondary objective was to relate Lp(a) levels to Major Adverse Cardiovascular Events (MACE) and femoral plaque composition that was acquired from baseline surgery. During a median follow-up time of 5.6 years, a total of 225 MALE were recorded in 132 patients. Multivariable analysis, including history of peripheral intervention, age, diabetes mellitus, end stage renal disease and PAD disease stages, showed that Lp(a) was independently associated with first (HR of 1.36 (95% CI 1.02–1.82) p = .036) and recurrent MALE (HR 1.36 (95% CI 1.10–1.67) p = .004). A total of 99 MACE were recorded but Lp(a) levels were not associated with MACE.sLp(a) levels were significantly associated with a higher presence of smooth muscle cells in the femoral plaque, although this was not associated with MALE or MACE. Plasma Lp(a) is independently associated with first and consecutive MALE after iliofemoral endarterectomy. Hence, in patients who undergo iliofemoral endarterectomy, Lp(a) could be considered as a biomarker to enhance risk stratification for future MALE. Created with BioRender.com [Display omitted] •Plasma lipoprotein(a) was, in multivariable models, associated with a primary and consecutive MALE after iliofemoral surgery.•Plasma lipoprotein(a) was not associated with MACE following iliofemoral surgery.•In iliofemoral atherosclerotic plaque, higher smooth muscle cell content was associated with higher lipoprotein(a) content.