Genetics
Elevated Lp(a) predicts worse graft occlusion and MACE after CABG, review argues for routine perioperative Lp(a) measurement (Ann Thorac Surg 2025)
Original title: Emerging Implications of Elevated Lipoprotein(a) Levels in Coronary Artery Bypass Graft Surgery
This review, reviewing PubMed/MEDLINE through March 2024, examines Lp(a)'s role in coronary artery bypass grafting (CABG) outcomes, a growing area of interest as preoperative optimisation of modifiable risk factors becomes central to nonurgent surgical revascularisation. The literature supports Lp(a) as a causal, independent risk factor for coronary artery disease pathogenesis, and elevated Lp(a) is linked to worse post-CABG outcomes, including higher graft occlusion incidence and more major adverse cardiovascular events; genetic variation influencing Lp(a) also appears to shape both disease progression and surgical outcomes. The authors note several Lp(a)-lowering therapies are now in phase 3 trials and show promise for improving post-CABG prognosis, and advocate for routine Lp(a) measurement in all CABG patients, while calling for dedicated analyses of these emerging agents specifically within cardiac surgical subcohorts.
Original abstract
Background: Coronary artery bypass grafting (CABG) remains a cornerstone in the management of coronary artery disease (CAD). In nonurgent surgical revascularization cases, preoperative optimization of modifiable risk factors can improve outcomes. There is increasing interest in the relationship between lipoprotein(a) levels and the risk for ischemic cardiovascular disease, particularly how CABG outcomes are in turn affected. This review highlights the role of lipoprotein(a) in the pathogenesis of CAD and CABG outcomes and discusses future directions for its optimal management in the perioperative period.
Methods: The PubMed/MEDLINE database was reviewed until March 2024 to capture publications that evaluated and/or described the relationship between lipoprotein(a) and CABG surgery or CAD outcomes.
Results: The available literature supports lipoprotein(a) as a causal and independent risk factor for the pathogenesis of CAD. Elevated lipoprotein(a) levels are associated with an increased risk of adverse post-CABG outcomes, including graft occlusion incidence and major adverse cardiovascular events. Genetic variations influencing lipoprotein(a) levels play a role in disease progression and surgical outcomes. Several therapies aimed at reducing lipoprotein(a) levels, currently in phase III clinical trials, show promise for improving the prognosis after CABG.
Conclusions: Among individuals undergoing surgical revascularization for CAD, lipoprotein(a) levels may help define risk and inform best practices for perioperative management. We advocate for the routine measurement of lipoprotein(a) in all patients undergoing CABG. Emerging lipoprotein(a)-lowering agents show promise for secondary prevention of cardiac events, although dedicated analyses in cardiac surgical subcohorts will be important to evaluate their role in improving CABG outcomes.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.