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Lp(a) and ACS

Acute Coronary Syndromes (ACS) 

  • Acute Coronary Syndrome (ACS) is a general term used by doctors that usually means a person is experiencing one of two things: a small or large heart attack or the person is suffering severe chest pain called an unstable angina (a heart attack has not yet occurred but is likely to happen, see Heart Attack Video).
  • Elevated Lipoprotein(a) (Lp(a)) is a causal, independent, genetic risk factor for CVD (cardiovascular disease) and heart attack.
  • Elevated Lp(a) plays a crucial role in the growth and destabilization of plaques resulting in ACS.1-5
  • Large quantities of Lp(a) can be detected in culprit lesions from patients with ACS compared to patients with stable plaques.6
  • Lp(a) excess is often the principal contributor to heart attacks in people with minimal plaque build-up and coronary spasm. Ironically, high Lp(a) levels are also implicated in the severity of the CAD (coronary artery disease).2, 7
  • High Lp(a) levels are highly correlated with the severity of ACS, recurrent events, poor prognosis, and increased mortality.3, 8-16
  • The thrombogenic and antifibrinolytic properties of Lp(a) result in persistent occlusion of coronary arteries with and without a heart attack.17, 18

Sources

1. Sun H, Unoki H, Wang X, et al. Lipoprotein(a) enhances advanced atherosclerosis and vascular calcification in WHHL transgenic rabbits expressing human apolipoprotein(a). J Biol Chem. Dec 6 2002;277(49):47486-47492.

2. Zampoulakis JD, Kyriakousi AA, Poralis KA, et al. Lipoprotein(a) is related to the extent of lesions in the coronary vasculature and to unstable coronary syndromes. Clin Cardiol. 2000;23(12):895-900.

3. Dangas G, Mehran R, Harpel PC, et al. Lipoprotein(a) and inflammation in human coronary atheroma: association with the severity of clinical presentation. J Am Coll Cardiol. 1998;32(7):2035-2042.

4. Katsouras CS, Karabina SA, Tambaki AP, et al. Serum lipoprotein(a) concentrations and apolipoprotein(a) isoforms: association with the severity of clinical presentation in patients with coronary heart disease. J Cardiovasc Risk. Oct 2001;8(5):311-317.

5. Kamstrup P. R., Tybjaerg-Hansen A, Nordestgaard BG. Lipoprotein(a) and risk of myocardial infarction – genetic epidemiologic evidence of causality. Scand J Clin Lab Invest. Jan 13 2011.

6. Enas EA. How to Beat the Heart Disease Epidemic among South Asians: A Prevention and Management Guide for Asian Indians and their Doctors. Downers Grove: Advanced Heart Lipid Clinic  USA; 2011.

7. Miwa K, Nakagawa K, Yoshida N, Taguchi Y, Inoue H. Lipoprotein(a) is a risk factor for occurrence of acute myocardial infarction in patients with coronary vasospasm. J Am Coll Cardiol. 2000;35(5):1200-1205.

8. Dangas G, Ambrose JA, D’Agate DJ, et al. Correlation of serum lipoprotein(a) with the angiographic and clinical presentation of coronary artery disease. Am J Cardiol. Feb 15 1999;83(4):583-585, A587.

9.  Stubbs P, Seed M, Lane D, Collinson P, Kendall F, Noble M. Lipoprotein(a) as a risk predictor for cardiac mortality in patients with acute coronary syndromes. Eur Heart J. 1998;19(9):1355-1364.

10. Lundstam U, Herlitz J, Karlsson T, Linden T, Wiklund O. Serum lipids, lipoprotein(a) level, and apolipoprotein(a) isoforms as prognostic markers in patients with coronary heart disease. J Intern Med. 2002;251(2):111-118.

11.  Ohashi H, Oda H, Ohno M, Watanabe S, Sakata S. Lipoprotein(a) as a risk factor for coronary artery disease in hemodialysis patients. Kidney Int Suppl. 1999;71:S242-244.

12. Glader CA, Birgander LS, Stenlund H, Dahlen GH. Is lipoprotein(a) a predictor for survival in patients with established coronary artery disease? Results from a prospective patient cohort study in northern Sweden. J Intern Med. Jul 2002;252(1):27-35.

13. Sandkamp M, Assman G. Lipoprotein (a) in PROCAM participants and young myocardial infarction survivors. In: Scanu A, ed. Lipoprotein (a). San Diego: Academic Press; 1990:205-209.

14. Cho J. Y., Jeong MH, Ahn Y, et al. High Lipoprotein(a) Levels are Associated With Long-Term Adverse Outcomes in Acute Myocardial Infarction Patients in High Killip Classes. Korean Circ J. Oct 2010;40(10):491-498.

15. Gonbert S, Saint-Jore B, Giral P, Doucet C, Chapman J, Thillet J. Molecular analysis of apo(a) fragmentation in polygenic hypercholesterolemia: characterization of a new plasma fragment pattern. Arterioscler Thromb Vasc Biol. 2001;21(8):1353-1358.

16. Wang JJ, Zhang CN, Meng Y, Han AZ, Gong JB, Li K. Elevated concentrations of oxidized lipoprotein(a) are associated with the presence and severity of acute coronary syndromes. Clin Chim Acta. Oct 2009;408(1-2):79-82.

17. Kim JW, Seo HS, Suh SY, et al. Relationship between lipoprotein(a) and spontaneous recanalization of infarct-related arteries in the early phase of acute myocardial infarction. Clin Cardiol. May 2008;31(5):211-216.

18. Enas EA. How to Beat the Heart Disease Epidemic among South Asians: A Prevention and Management Guide for Asian Indians and their Doctors. Downers Grove: Advanced Heart Lipid Clinic  USA; 2010.

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