Coronary Procedures
- Cynomolgus monkeys with high lipoprotein(a) (Lp(a)) levels develop occlusive thrombus (blood clot) following arterial injury.1 A similar phenomenon occurs in humans following coronary angioplasty, stent, and bypass surgery leading to restenosis and repeat coronary procedures.2
- Lp(a) accumulates at sites of vascular injury, where the effective concentration is several times higher than in plasma, owing to selective retention in the arterial intima. This could result in malignant progression of atherosclerosis or restenosis following coronary procedures such as coronary angioplasty, stent and/or bypass surgery.2-5
- Repeat coronary procedures have a huge economic impact on individual and national economy.2 6, 7 The provocative report of a 56-year old man receiving 67 stents over a period of 10 years (Figure 038) illustrates this burden.8
- High levels of Lp(a) have been highly correlated with an increased risk of restenosis after coronary angioplasty.9-15 The combination of high Lp(a) levels with low HDL-C levels could lead to even higher rates of restenosis and is particularly common among Asian Indians.16, 17 Besides, patients with excess Lp(a) have a poorer prognosis and greater mortality following these procedures.18-20
- Restenosis rates following coronary angioplasty have been shown to be reduced by more than 50% by lowering Lp(a) with apheresis and niacin therapy,21-23 whereas lowering LDL with a statin has not been associated with reduction in restenosis rates following coronary procedures.2
- Lp(a) accumulates more avidly than LDL in bypass graft tissue, and high levels of Lp(a) are also associated with coronary artery bypass graft stenosis.24-27
Sources
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3. Pepin JM, O’Neil JA, Hoff HF. Quantification of apo[a] and apoB in human atherosclerotic lesions. Journal of lipid research. Feb 1991;32(2):317-327.
4. Kreuzer J, Lloyd MB, Bok D, et al. Lipoprotein (a) displays increased accumulation compared with low-density lipoprotein in the murine arterial wall. Chem Phys Lipids. Jan 1994;67-68:175-190.
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20. Zairis MN, Ambrose JA, Manousakis SJ, et al. The impact of plasma levels of C-reactive protein, lipoprotein (a) and homocysteine on the long-term prognosis after successful coronary stenting. The global evaluation of new events and restenosis after stent implantation study. J Am Coll Cardiol. 2002;40(8):1375.
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26. Hoff HF, Beck G, Skibinski C, et al. Serum Lp(a) level as a predictor of vein graft stenosis after coronary artery bypass surgery in patients. Circulation. 1988;77(6):1238-1244.
27. Pokrovsky S. N., Ezhov MV, Il’ina LN, et al. Association of lipoprotein(a) excess with early vein graft occlusions in middle-aged men undergoing coronary artery bypass surgery. J Thorac Cardiovasc Surg. Oct 2003;126(4):1071-1075.