title: Lipoprotein(a) level and apolipoprotein(a) phenotype as predictors of long-term cardiovascular outcomes after coronary artery bypass grafting.
abstract: OBJECTIVE
  To evaluate the relationships of lipoprotein(a) (Lp(a)) concentration and apolipoprotein(a) (apo(a)) phenotype to major adverse cardiovascular events after coronary artery bypass grafting (CABG) in long-term follow-up.
  
  
  METHODS
  This single-center study included 356 patients with stable coronary heart disease (CHD) who underwent successful CABG. At baseline, we assessed the patient's risk factor profile for atherosclerosis, Lp(a) concentration and apo(a) phenotype. The primary endpoint was the composite of cardiovascular death and non-fatal myocardial infarction (MI). The secondary endpoint also included hospitalization for recurrent or unstable angina and repeat revascularization.
  
  
  RESULTS
  Over a mean of 8.5 ± 3.5 years (range 0.9-15.0 years), the primary and secondary endpoints were registered in 46 (13%) and 107 (30%) patients, respectively. Patients with Lp(a) ≥30 mg/dL were at significantly greater risk for the primary endpoint (hazard ratio (HR) 2.98, 95% confidence interval (CI) 1.76-5.03, p < 0.001) and secondary endpoint (HR 3.47, 95% CI 2.48-4.85, p < 0.001) than patients with Lp(a) values <30 mg/dL. The low molecular-weight apo(a) phenotype was also associated with higher risk of both primary and secondary endpoints (3.57 (1.87-6.82) and 3.05 (2.00-4.62), respectively; p < 0.001 for both), regardless of conventional risk factors and statins use.
  
  
  CONCLUSIONS
  In stable CHD patients Lp(a) concentration and low molecular-weight apo(a) phenotype are independently associated with three-fold increase in risk of major adverse cardiovascular events within 15 years after CABG. Lp(a) levels may provide an additional information for postoperative cardiovascular risk assessment.
authors: Atherosclerosis Department, Institute of Clinical Cardiology named after A.L. Myasnikov, Federal State Institution "Russian Cardiology Research and Production Complex" of Ministry of Health of the Russian Federation, 15A, 3rd Cherepkovskaya street, Moscow 121552, Russia. Electronic address: Marat_Ezhov@mail.ru.
authors: Marat V
authors: MV
authors: Ezhov
authors: Atherosclerosis Department, Institute of Clinical Cardiology named after A.L. Myasnikov, Federal State Institution "Russian Cardiology Research and Production Complex" of Ministry of Health of the Russian Federation, 15A, 3rd Cherepkovskaya street, Moscow 121552, Russia. Electronic address: Dr.Safarova@gmail.com.
authors: Maya S
authors: MS
authors: Safarova
authors: Laboratory of Atherosclerosis, Institute of Experimental Cardiology, Federal State Institution "Russian Cardiology Research and Production Complex" of Ministry of Health of the Russian Federation, 15A, 3rd Cherepkovskaya street, Moscow 121552, Russia. Electronic address: Afanasieva@cardio.ru.
authors: Olga I
authors: OI
authors: Afanasieva
authors: Atherosclerosis Department, Institute of Clinical Cardiology named after A.L. Myasnikov, Federal State Institution "Russian Cardiology Research and Production Complex" of Ministry of Health of the Russian Federation, 15A, 3rd Cherepkovskaya street, Moscow 121552, Russia. Electronic address: v_kukharch@mail.ru.
authors: Valery V
authors: VV
authors: Kukharchuk
authors: Laboratory of Atherosclerosis, Institute of Experimental Cardiology, Federal State Institution "Russian Cardiology Research and Production Complex" of Ministry of Health of the Russian Federation, 15A, 3rd Cherepkovskaya street, Moscow 121552, Russia. Electronic address: Dr.Pokrovsky@mail.ru.
authors: Sergei N
authors: SN
authors: Pokrovsky
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000150:complications; D053241:Apoprotein(a) / Q000378:metabolism*; D050197:Atherosclerosis / Q000209:etiology; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D017270:Lipoprotein(a) / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D010641:Phenotype; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017270:Lipoprotein(a); D053241:Apoprotein(a)
keywords: Apo(a) phenotype; Apolipoprotein(a); Coronary artery bypass grafting; Coronary heart disease; Lipoprotein(a); Long-term prognosis; Vein graft disease