Genetics
Lp(a) above 30 mg/dL triples the risk of death or heart attack after bypass surgery, a Russian study of 356 patients followed 15 years (Atherosclerosis 2014)
Original title: Lipoprotein(a) level and apolipoprotein(a) phenotype as predictors of long-term cardiovascular outcomes after coronary artery bypass grafting
This single-center study followed 356 patients with stable coronary heart disease who underwent successful coronary artery bypass grafting (CABG) for a mean 8.5 years (range 0.9-15.0) to assess whether Lp(a) and apolipoprotein(a) phenotype predict long-term cardiovascular outcomes. The primary endpoint (cardiovascular death or non-fatal myocardial infarction) occurred in 46 patients (13%) and the secondary endpoint (also including hospitalization for angina or repeat revascularization) in 107 (30%). Patients with Lp(a) at or above 30 mg/dL had significantly greater risk of the primary endpoint (hazard ratio 2.98, 95% CI 1.76-5.03, P<0.001) and secondary endpoint (hazard ratio 3.47, 95% CI 2.48-4.85, P<0.001) than those below 30 mg/dL, and the low molecular-weight apo(a) phenotype was similarly associated with higher risk of both endpoints (hazard ratios 3.57 and 3.05, both P<0.001), regardless of conventional risk factors and statin use. The findings show Lp(a) and low molecular-weight apo(a) phenotype independently triple the risk of major cardiovascular events within 15 years after CABG.
Original abstract
Objective: To evaluate the relationships of lipoprotein(a) (Lp(a)) concentration and apolipoprotein(a) (apo(a)) phenotype to major adverse cardiovascular events after coronary artery bypass grafting (CABG) in long-term follow-up.
Methods: This single-center study included 356 patients with stable coronary heart disease (CHD) who underwent successful CABG. At baseline, we assessed the patient's risk factor profile for atherosclerosis, Lp(a) concentration and apo(a) phenotype. The primary endpoint was the composite of cardiovascular death and non-fatal myocardial infarction (MI). The secondary endpoint also included hospitalization for recurrent or unstable angina and repeat revascularization.
Results: Over a mean of 8.5 ± 3.5 years (range 0.9-15.0 years), the primary and secondary endpoints were registered in 46 (13%) and 107 (30%) patients, respectively. Patients with Lp(a) ≥30 mg/dL were at significantly greater risk for the primary endpoint (hazard ratio (HR) 2.98, 95% confidence interval (CI) 1.76-5.03, p < 0.001) and secondary endpoint (HR 3.47, 95% CI 2.48-4.85, p < 0.001) than patients with Lp(a) values <30 mg/dL. The low molecular-weight apo(a) phenotype was also associated with higher risk of both primary and secondary endpoints (3.57 (1.87-6.82) and 3.05 (2.00-4.62), respectively; p < 0.001 for both), regardless of conventional risk factors and statins use.
Conclusion: In stable CHD patients Lp(a) concentration and low molecular-weight apo(a) phenotype are independently associated with three-fold increase in risk of major adverse cardiovascular events within 15 years after CABG. Lp(a) levels may provide an additional information for postoperative cardiovascular risk assessment.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.