Lp(a) predicts post-PCI cardiac events in coronary disease and diabetes, but evidence is inconsistent, review of four studies (Am J Med Sci 2026)

Original title: Association of Lipoprotein(A) levels and post-revascularization major cardiac events in coronary artery disease and diabetes

Am J Med Sci · 21 December 2025 · 5

Brereton B, Desai R, Nathani PS, Prakash SH, Nair A, Lewis C, Sidhu A, Usman S, Chauhan S, Vivekanand VA, Nanjundappa A, Sunkara P

Systematic review of four studies (3 prospective, 1 retrospective; total 4624 patients, 3719 male) examining Lp(a) and post-revascularisation major adverse cardiac events (MACE) in coronary artery disease, acute coronary syndrome and diabetes. Konishi et al. found elevated Lp(a) independently predicted cardiac death or ACS recurrence in diabetics after PCI (adjusted OR 1.20, 95% CI 1.00-1.42, p=0.04); Takahashi et al. found high Lp(a) independently predicted MACE (adjusted OR 1.83, 95% CI 1.16-2.95, p=0.009). Silverio et al. found elevated Lp(a) (above 70 mg/dL) predicted recurrent MI and death in non-diabetic patients (adjusted OR 2.839, 95% CI 1.382-5.832, p=0.005) but not in diabetics (OR 1.115, 95% CI 0.405-3.071, p=0.833). The authors conclude Lp(a) is likely an independent MACE risk factor after PCI, with some evidence of worse prognosis in diabetes, though this association is inconsistent across studies and warrants confirmation in larger prospective multicentre studies.

Original abstract

Background: Lipoprotein (a) [Lp (a)] may confer pro-thrombotic potential, and high concentrations may be an independent risk for MI. This systematic review sought to investigate the association of Lp (a) levels with post-revascularization Major Adverse Cardiac Events (MACE) in patients with CAD, ACS, and DM.

Methods: A systematic literature search for original investigations was performed using PubMed/MEDLINE, Embase, Scopus, and Google Scholar, searching for articles (meeting inclusion criteria) focusing on the relationship between Lp(a), DM, and PCI in patients with ACS, MI, or IHD and the impact on cardiovascular outcomes. The data was abstracted and descriptively summarized.

Results: The systematic review selected four relevant articles: 3 prospective Konishi et al., (2016); Silverio et al., (2022); and Li et al., (2023) and one retrospective (Takahashi et al., 2020). Total population: 4624, total males: 3719. Konishi et al. (2016) concluded that an elevated Lp(a) is an independent risk factor for cardiac death and/or ACS recurrence in diabetics undergoing PCI. The adjusted OR for cardiac death and ACS in the high Lp(a) group vs. the low Lp(a) group was 1.20 (CI 1.00-1.42), p = 0.04. Takahashi et al. (2020) showed that after adjusting for clinical covariates, high Lp(a) was independently associated with a higher frequency of MACE and poorer long-term outcomes compared to low Lp(a). The adjusted OR for the risk of MACE in patients with high Lp (a) vs. low Lp (a) was 1.83 (CI 1.16-2.95), p = 0.009. Silverio et al. (2022) showed that while there was an increased risk of recurrent MI in this patient population without DM, it was not confirmed in patients with DM. Compared with the lowest Lp (a) category, non-DM patients with very high Lp (a) >70 mg/dl vs. low Lp (a) showed a higher risk of recurrent MI and all-cause death; adjusted OR 2.839 (CI 1.382-5.832), p = 0.005. In diabetics, high Lp (a) vs. low Lp (a) = 1.115 (CI 0.405-3.071), p = 0.833.

Conclusions: There is some evidence that Lp (a) levels are an independent risk factor for MACE in patients who underwent PCI for CAD. There is also some evidence that elevated Lp (a) levels are associated with a worse prognosis in patients with DM after PCI, but this association is not consistent in the literature. Further prospective multicenter studies are required in order to elucidate this association.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.