Combined elevation of Lp(a) and hs-CRP, not Lp(a) alone, raises platelet reactivity on clopidogrel in 6,615 PCI patients (Clin Appl Thromb Hemost 2024)

Original title: Elevated High-Sensitivity C-Reactive Protein Level Enhances the Impact of Lipoprotein(a) on Platelet Reactivity in PCI Patients Treated with Clopidogrel

Clin Appl Thromb Hemost · 1 January 2024 · 6

Zhang K, Li J, Li Y, Yan K, Zhu P, Tang X, Yuan D, Yang Y, Gao R, Yuan J, Zhao X

Among 6,615 patients undergoing percutaneous coronary intervention with clopidogrel therapy at Fuwai Hospital (mean age 58.24 years, 77.6% men), platelet reactivity was assessed by thromboelastography. Isolated elevation of Lp(a) (>=30 mg/dL) with normal hs-CRP (<2 mg/L) was not significantly associated with high or low on-treatment platelet reactivity. However, joint elevation of Lp(a) (>=30 mg/dL) and hs-CRP (>=2 mg/L) was associated with both high on-treatment platelet reactivity (OR 1.976, 95% CI 1.677-2.329) and low on-treatment platelet reactivity (OR 0.533, 95% CI 0.454-0.627) relative to patients with both markers low. The findings suggest inflammation modifies the thrombotic impact of Lp(a), raising the question of whether intensified antiplatelet or anti-inflammatory therapy could help this subgroup.

Original abstract

Background: Recently, the effect of Lipoprotein(a) [Lp(a)] on thrombogenesis has aroused great interest, while inflammation has been reported to modify the Lp(a)-associated risks through an unidentified mechanism.

Purpose: This study aimed to evaluate the association between platelet reactivity with Lp(a) and high-sensitivity C-reactive protein (hs-CRP) levels in percutaneous intervention (PCI) patients treated with clopidogrel.

Methods: Data were collected from 10,724 consecutive PCI patients throughout the year 2013 in Fuwai Hospital. High on-treatment platelet reactivity (HTPR) and low on-treatment platelet reactivity (LTPR) were defined as thrombelastography (TEG) maximum amplitude of adenosine diphosphate-induced platelet (MAADP) > 47 mm and < 31 mm, respectively.

Results: 6615 patients with TEG results were finally enrolled. The mean age was 58.24 ± 10.28 years and 5131 (77.6%) were male. Multivariable logistic regression showed that taking Lp(a) < 30 mg/dL and hs-CRP < 2 mg/L as the reference, isolated Lp(a) elevation [Lp(a) ≥ 30 mg/dL and hs-CRP < 2 mg/L] was not significantly associated with HTPR (P = 0.153) or LTPR (P = 0.312). However, the joint elevation of Lp(a) and hs-CRP [Lp(a) ≥ 30 mg/dL and hs-CRP ≥ 2 mg/L] exhibited enhanced association with both HTPR (OR:1.976, 95% CI 1.677-2.329) and LTPR (OR:0.533, 95% CI 0.454-0.627).

Conclusions: The isolated elevation of Lp(a) level was not an independent indicator for platelet reactivity, yet the concomitant elevation of Lp(a) and hs-CRP levels was significantly associated with increased platelet reactivity. Whether intensified antiplatelet therapy or anti-inflammatory strategies could mitigate the risks in patients presenting combined Lp(a) and hs-CRP elevation requires future investigation.

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