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3rd November 2022
Elevated levels of both C-reactive protein (CRP) levels and lipoprotein A (LpA) in those with coronary heart disease undergoing a percutaneous coronary intervention (PCI) result in a greater risk of major adverse cardiovascular and cerebrovascular events according to the results of a study by Chinese researchers.
The risk of a recurrent vascular event in patients with established cardiovascular disease remains even in those with optimal treatment. For example, one study has found that when risk factors are modified to achieve guideline recommended targets, the residual 10-year risk while < 10% in 47% of patients is >30% in 9%. One factor associated with this residual risk is inflammation and it has been found that patients who have low CRP levels after statin therapy, had better clinical outcomes than those with higher CRP levels, regardless of the resultant level of LDL cholesterol. Furthermore, clinical and genetic research studies have also shown that lipoprotein A has a crucial role in the pathogenesis of cardiovascular disease. In fact, it has been found that elevated LpA levels during treatment of cardiovascular disease are related to cardiovascular-related death when CRP levels are > 2 mg/L. Nevertheless, much less is known about the relationship between CRP and LpA levels in patients undergoing PCI.
For the present study, the Chinese team set out to examine the joint and independent association between LpA and CRP levels among patients with coronary artery disease who underwent a PCI. The researchers used data from a prospective, observational cohort at a national tertiary care centre and identified patients undergoing PCI and where LpA and CRP levels had been measured. Patients were followed-up for 5 years after discharge and the team set the primary endpoint as major adverse cardiac and cerebrovascular events (MACCE), which was a composite of all-cause mortality, myocardial infarction, unplanned revascularisation and ischaemic stroke.
C-reactive protein and lipoprotein A levels and MACCE
A total of 10,424 patients with a mean age of 58.4 years (77.2% male) were included in the analysis. The median level of LpA was 18.53 mg/dL and CRP 1.62 mg/L. After 5 years of follow-up, the primary endpoint (MACCE) occurred in 20.5% of participants.
Multivariable analysis showed that when LpA levels were > 30 mg/dL there was a higher risk of MACCE (Hazard ratio, HR = 1.14, 95% CI 1.05 – 1.25, p < 0.05) compared to levels below 30 mg/dL. Similarly, CRP levels above 2 mg/L were also significantly associated with a greater risk of MACCE (HR = 1.10, 95% CI 1.01 – 1.20, p < 0.05).
But when both LpA and CRP were higher than 30 mg/dL and 2 mg/L respectively, in fully adjusted models, there was a 22% higher risk of MACCE (HR = 1.22, 95% CI 1.07 – 1.39, p < 0.05).
The authors concluded that elevated LpA levels were associated with a higher risk of adverse cardiovascular events and that this risk was even higher when C-reactive protein levels were above 2 mg/L. They suggested that measuring levels of both could help identify high-risk individuals and who might benefit from further therapeutic interventions.
Yuan D et al. Lipoprotein(a), high-sensitivity C-reactive protein, and cardiovascular risk in patients undergoing percutaneous coronary intervention Atherosclerosis 2022