High lipoprotein(a) is associated with major adverse limb events after femoral artery endarterectomy

Background and Aims : Elevated lipoprotein(a) (Lp[a]) has been identified as a causal risk factor for cardiovascular disease including peripheral arterial disease (PAD). Although Lp(a) is associated with the diagnosis of PAD, it remains elusive whether there is an association of Lp(a) with cardiovascular and limb events in patients with severe PAD.Methods: Preoperative plasma Lp(a) levels were measured in 384 consecutive patients that underwent femoral endarterectomy and were included in the Athero-Express biobank. Our primary objective was to assess the association of Lp(a) levels with Major Adverse Limb Events (MALE). Our secondary objective was to relate Lp(a) levels to Major Adverse Cardiovascular Events (MACE) and femoral plaque composition that was acquired from baseline surgery.Results: During a median follow-up time of 5.6 years, a total of 225 MALE were recorded in 132 patients. Multivariable analysis, including history of peripheral intervention, age, diabetes mellitus, end stage renal disease and Fontaine stages, showed that Lp(a) was independently associated with first (HR of 1.36 (95% CI 1.02-1.82) p =.036) and recurrent MALE (HR 1.36 (95% CI 1.10 – 1.67) p =.004). Lp(a) levels were not associated with MACE (HR 0.88 (95% CI 0.63-1.23); p = .45). A higher presence of smooth muscle cells was seen in atherosclerotic plaque of patients with higher Lp(a) levels, although this was not associated with endpoints.Conclusions: Plasma Lp(a) is independently associated with first and consecutive MALE after femoral endarterectomy. Consequently, Lp(a) could be considered as a biomarker to improve risk stratification in patients undergoing femoral endarterectomy. Background and Aims : Elevated lipoprotein(a) (Lp[a]) has been identified as a causal risk factor for cardiovascular disease including peripheral arterial disease (PAD). Although Lp(a) is associated with the diagnosis of PAD, it remains elusive whether there is an association of Lp(a) with cardiovascular and limb events in patients with severe PAD. Methods: Preoperative plasma Lp(a) levels were measured in 384 consecutive patients that underwent femoral endarterectomy and were included in the Athero-Express biobank. Our primary objective was to assess the association of Lp(a) levels with Major Adverse Limb Events (MALE). Our secondary objective was to relate Lp(a) levels to Major Adverse Cardiovascular Events (MACE) and femoral plaque composition that was acquired from baseline surgery. Results: During a median follow-up time of 5.6 years, a total of 225 MALE were recorded in 132 patients. Multivariable analysis, including history of peripheral intervention, age, diabetes mellitus, end stage renal disease and Fontaine stages, showed that Lp(a) was independently associated with first (HR of 1.36 (95% CI 1.02-1.82) p =.036) and recurrent MALE (HR 1.36 (95% CI 1.10 – 1.67) p =.004). Lp(a) levels were not associated with MACE (HR 0.88 (95% CI 0.63-1.23); p = .45). A higher presence of smooth muscle cells was seen in atherosclerotic plaque of patients with higher Lp(a) levels, although this was not associated with endpoints. Conclusions: Plasma Lp(a) is independently associated with first and consecutive MALE after femoral endarterectomy. Consequently, Lp(a) could be considered as a biomarker to improve risk stratification in patients undergoing femoral endarterectomy.