No association found between Lp(a) and cardiovascular mortality in 1,222 patients with peripheral artery disease after revascularisation (Atherosclerosis 2022)

Original title: Lipoprotein (a) and long-term outcome in patients with peripheral artery disease undergoing revascularization

Atherosclerosis · 13 October 2022 · 6

Zierfuss B, Höbaus C, Feldscher A, Hannes A, Mrak D, Koppensteiner R, Stangl H, Schernthaner GH

In two cohorts totalling 1,222 patients with symptomatic peripheral artery disease (PAD) who underwent endovascular repair, measured with Lp(a) in nmol/L (n=964, followed 4.3 years) or mg/dL (n=258, followed 7.6 years), 141 and 64 cardiovascular deaths occurred respectively (annual rates 3.4% and 3.3%). After adjustment for traditional cardiovascular risk factors, Lp(a) was not significantly associated with cardiovascular mortality in either cohort (highest tertile HR 1.47, 95% CI 0.96-2.24; and HR 1.34, 95% CI 0.70-2.58), nor in subgroups by claudication, critical limb ischaemia, or concomitant coronary artery disease. The findings show no clear link between elevated Lp(a) and cardiovascular mortality in this large symptomatic PAD cohort, contrasting with Lp(a) established role in PAD incidence, and the authors call for longer studies including asymptomatic patients.

Original abstract

Background And Aims: Despite low LDL-C goals, the residual risk for further cardiovascular (CV) events in patients with peripheral artery disease (PAD) remains high. Lipoprotein (a) (Lp(a)) is a known risk factor for PAD incidence, but little is known regarding the outcome in patients with symptomatic PAD. Thus, this study investigates Lp(a) and CV mortality in PAD after endovascular repair.

Methods: A total of 1222 patients with PAD in two cohorts according to Lp(a) assay in nmol/L (n = 964, Lip-LEAD-A) or mg/dl (n = 258, Lip-LEAD-B) were followed up for 4.3 (IQR 3.0-5.6) or 7.6 (IQR 3.2-8.1) years. Lp(a) was measured before endovascular repair for either intermittent claudication (IC) or critical limb ischemia (CLI). Outcome information was obtained from the federal death registry.

Results: In Lip-LEAD-A, 141 CV-deaths occurred (annual calculated CV-death rate 3.4%), whereas 64 CV-deaths were registered in Lip-LEAD-B (annual calculated CV-death rate 3.3%). After adjustment for traditional CV risk factors Lp(a) was neither associated with outcome in Lip-LEAD-A (highest tertile HR 1.47, 95%CI [0.96-2.24]) nor in Lip-LEAD-B (highest tertile HR 1.34 [0.70-2.58]). Subanalyses for IC (HR 1.37 [0.74-2.55]; HR 1.10 [0.44-2.80], CLI (HR 1.55 [0.86-2.80], HR 3.01 [0.99-9.10]), or concomitant coronary artery disease (CAD; HR 1.34 [0.71-2.54]; HR 1.21 [0.46-3.17]) failed to show a significant association between Lp(a) and CV-mortality.

Conclusions: In this large-scale cohort of symptomatic PAD no association of elevated Lp(a) with CV mortality was found over a median observation period of 5 years. Thus, an even longer study including asymptomatic patients is warranted.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.