Epidemiology
Over 1 in 5 of 18,544 bypass surgery patients had high Lp(a), which raised death risk 31% and was blunted by arterial grafts (J Am Heart Assoc 2024)
Original title: Impact of High Lipoprotein(a) on Long-Term Survival Following Coronary Artery Bypass Grafting
In 18,544 consecutive patients with stable coronary artery disease who underwent isolated coronary artery bypass grafting (CABG) between 2013 and 2018 at a single centre, 4,072 (22.0%) had high Lp(a) (50 mg/dL or above). Over a median 3.2-year follow-up, 587 patients died. High Lp(a) was independently associated with all-cause death (adjusted hazard ratio 1.31, 95% CI 1.09-1.59, P = 0.005; per 1 mg/dL increase, adjusted hazard ratio 1.003, P = 0.011) and major adverse cardiovascular and cerebrovascular events (adjusted hazard ratio 1.18, 95% CI 1.06-1.33, P = 0.004). The Lp(a)-related risk was greater in patients with a low European System for Cardiac Operative Risk Evaluation score, and tended to attenuate in those receiving arterial grafts. More than one in five stable CABG patients have high Lp(a), which independently predicts worse survival and cardiovascular outcomes, an effect most pronounced in clinically low-risk patients and less evident when arterial grafts are used.
Original abstract
Background: Lipoprotein(a) is a possible causal risk factor for atherosclerosis and related complications. The distribution and prognostic implication of lipoprotein(a) in patients undergoing coronary artery bypass grafting remain unknown. This study aimed to assess the impact of high lipoprotein(a) on the long-term prognosis of patients undergoing coronary artery bypass grafting.
Methods And Results: Consecutive patients with stable coronary artery disease who underwent isolated coronary artery bypass grafting from January 2013 to December 2018 from a single-center cohort were included. The primary outcome was all-cause death. The secondary outcome was a composite of major adverse cardiovascular and cerebrovascular events. Of the 18 544 patients, 4072 (22.0%) were identified as the high-lipoprotein(a) group (≥50 mg/dL). During a median follow-up of 3.2 years, primary outcomes occurred in 587 patients. High lipoprotein(a) was associated with increased risk of all-cause death (high lipoprotein(a) versus low lipoprotein(a): adjusted hazard ratio [aHR], 1.31 [95% CI, 1.09-1.59]; P=0.005; lipoprotein(a) per 1-mg/dL increase: aHR, 1.003 [95% CI, 1.001-1.006]; P=0.011) and major adverse cardiovascular and cerebrovascular events (high lipoprotein(a) versus low lipoprotein(a): aHR, 1.18 [95% CI, 1.06-1.33]; P=0.004; lipoprotein(a) per 1-mg/dL increase: aHR, 1.002 [95% CI, 1.001-1.004]; P=0.002). The lipoprotein(a)-related risk was greater in patients with European System for Cardiac Operative Risk Evaluation <3, and tended to attenuate in patients receiving arterial grafts.
Conclusions: More than 1 in 5 patients with stable coronary artery disease who underwent coronary artery bypass grafting were exposed to high lipoprotein(a), which is associated with higher risks of death and major adverse cardiovascular and cerebrovascular events. The adverse effects of lipoprotein(a) were more pronounced in patients with clinically low-risk profiles or not receiving arterial grafts.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.