Breaking News
January 23, 2018 - Findings provide better understanding of cognitive inflexibility in Fragile X Syndrome
January 23, 2018 - Powerful anti-oxidant can stop progression of fatty liver disease in young mice
January 23, 2018 - Study shows value of occupational therapy in the lives of young adults with diabetes
January 23, 2018 - Researchers seek to understand effect of very low birth weight on the brain
January 23, 2018 - Be a Savvy Supermarket Shopper
January 23, 2018 - NIH Striving to Avoid False Hope in Chronic Fatigue
January 23, 2018 - ClinicalTrials.gov: Occupational Stress
January 23, 2018 - PrEP could make US easily hit its 2020 HIV prevention goal, study finds
January 23, 2018 - Study finds considerable variation in hip fracture rates across nursing homes
January 23, 2018 - Evidence-based approach to preventing or treating caries could transform dental care
January 22, 2018 - TAVR Discharge Timing; Stentreiver Anesthesia; New Valve Depression
January 22, 2018 - Could sugar be responsible for the obesity and diabetes epidemics?
January 22, 2018 - Mallinckrodt Completes Stannsoporfin New Drug Application Filing
January 22, 2018 - ACOG Backs ‘Cascade Testing’ for Cancer-Related Mutations
January 22, 2018 - The terrible toll tennis can take on top players who play too much
January 22, 2018 - KAIST scientists identify cellular mechanism for severe viral hepatitis
January 22, 2018 - New genomic tools provide better understanding of the human immune system
January 22, 2018 - Improving QoL with an App?
January 22, 2018 - Researchers identify virus as likely cause of mystery polio-like paralysis
January 22, 2018 - First step toward CRISPR cure of Lou Gehrig’s disease
January 22, 2018 - Scientists uncover the proteins responsible for movement
January 22, 2018 - New clinical practice guideline provides recommendations for use of anticoagulants during heart surgery
January 22, 2018 - Depressive symptoms associated with poorer survival in patients with head and neck cancer
January 22, 2018 - Restaurant Bans Have Big Impact on Smoking Rates
January 22, 2018 - D.C. Week: CMS Outlines Path for Medicaid Work Mandate
January 22, 2018 - Study identifies new loci associated with asthma enriched in epigenetic marks
January 22, 2018 - Researchers explore impact of smart rollator in motivating seniors to increase physical activity
January 22, 2018 - New bug may reduce misery of hay fever sufferers
January 22, 2018 - Specially prepared supplement helps women to run faster, study shows
January 22, 2018 - 3-D Stent Retriever with Aspiration Proves Mettle in AIS
January 22, 2018 - Public health research seeks to understand how natural disasters impact spread of Zika
January 22, 2018 - Research reveals role of nanophenomenon in stimulating bone-repair process
January 22, 2018 - Drinking during late adolescence could be first step to liver problems in adulthood
January 22, 2018 - Epilepsy associated with volume and thickness differences in brain matter
January 22, 2018 - Trevena Announces FDA Acceptance for Review of New Drug Application for Olinvo (oliceridine) Injection
January 22, 2018 - A Noteworthy Margin of Error
January 22, 2018 - Firm advances human trials of revolutionary vaccine
January 22, 2018 - Many Indians put away treating orthopedic problems
January 22, 2018 - Cherwell releases new pocket guide to prepared culture media
January 22, 2018 - Huron earns ISO 13485 certification for quality management system
January 22, 2018 - Avion Pharmaceuticals Announces FDA Approval of Balcoltra (levonorgestrel and ethinyl estradiol tablets and ferrous bisglycinate tablets) Oral Contraceptive
January 22, 2018 - Multi-Gene Test For Early CVD; Neighborhood HF Risk; Novel Testosterone Drugs
January 22, 2018 - Skipping breakfast disrupts ‘clock genes’ that regulate body weight
January 22, 2018 - Creativity May Rely on ‘Teamwork’ in the Brain
January 22, 2018 - NeuroBreak: Alzheimer’s Germ Contest; High Salt Diet May Be Bad for Brain
January 22, 2018 - Diabetics may often fare poorly in hospice care
January 22, 2018 - Performance enhancing benefits of caffeine more apparent for infrequent tea, coffee drinkers
January 22, 2018 - HHS Unveils Framework for Interoperability
January 22, 2018 - More dentists to discuss risks of HPV-related cancers with their patients
January 21, 2018 - Research shows how Zika virus damages placenta to cause malformations in babies
January 21, 2018 - Achaogen Announces FDA Acceptance of New Drug Application with Priority Review for Plazomicin for Treatment of Complicated Urinary Tract Infections and Bloodstream Infections
January 21, 2018 - Drug Allergies: Time to Re-Test?
January 21, 2018 - Mitochondrial protein in cardiac muscle cells linked to heart failure, study finds
January 21, 2018 - Women more likely than men to die from a heart attack
January 21, 2018 - Next generation genomic sequencing can help detect pathogens after joint replacement
January 21, 2018 - Gov’t Shutdown Looms as Senate Debates Spending Bill
January 21, 2018 - Emergency Readiness for Older Adults and People with Disabilities
January 21, 2018 - Heart health at risk for Latinas over worries about deportation
January 21, 2018 - Scientists methodically identify genes related to blood feeding and non-biting mosquitoes
January 21, 2018 - Researchers discover potential target genes to halt thyroid cancer progression
January 21, 2018 - Youth with shared residency after parents’ divorce have less mental issues
January 21, 2018 - Sleep Better, Lose Weight? – Drugs.com MedNews
January 21, 2018 - More $$ Needed for Health Emergencies, Senators Told
January 21, 2018 - Gene test to predict breast cancer recurrence less cost effective in real world practice
January 21, 2018 - Study finds rise in number of adolescents receiving psychiatric or neurodevelopmental diagnosis
January 21, 2018 - Reminders can improve immunization rates
January 21, 2018 - A More Personalized Approach to PSA Screening in 2017
January 21, 2018 - T-cells engineered to outsmart tumors induce clinical responses in relapsed Hodgkin lymphoma
January 21, 2018 - Tetraphase Pharmaceuticals Announces Submission of New Drug Application to FDA for Eravacycline for the Treatment of Complicated Intra-Abdominal Infections (cIAI)
January 21, 2018 - Have Robotics Had a Detrimental Effect on Surgical Residency?
January 21, 2018 - Being bilingual may help autistic children
January 21, 2018 - Metrics Are Not Widespread in Rheumatoid Care
January 21, 2018 - Neuroanatomic abnormalities ID’d in those at risk for autism
January 21, 2018 - Children born with Down’s syndrome have superior genome that compensates for disability
January 21, 2018 - Study finds higher risks for asymptomatic paroxysmal AF patients
January 21, 2018 - The Second Stage of Diet Resolutions
January 21, 2018 - CT Scans Reduce Lung Cancer Deaths … But Among Whom?
January 21, 2018 - ADHD drug use soars among young women
January 21, 2018 - Researchers propose new regulation mechanism linked to action of SirT6 on chromatin
January 21, 2018 - Statins appear to reduce risk of repeated surgery in patients who undergo vitrectomy
Lipoprotein(a) Not Prognostic After ACS

Lipoprotein(a) Not Prognostic After ACS

image_pdfDownload PDFimage_print

Level of lipoprotein(a), or Lp(a), doesn’t predict recurrent cardiovascular events immediately after an acute coronary syndrome (ACS) in the context of good medical therapy, according to an ad hoc analysis of the dal-Outcomes trial.

Median Lp(a) level did not differ substantially between those who did and did not have subsequent events, Gregory Schwartz, MD, PhD, of Denver’s Veterans Affairs Medical Center, and colleagues reported online in JAMA Cardiology.

In a case-cohort regression analysis, having twice as much Lp(a) was not associated with greater risk of ischemic cardiovascular events over a median 29 months of follow-up (adjusted HR 1.01, 95% CI 0.96-1.06). And even the highest deciles were not associated with significantly greater risk.

“These findings call into question whether treatment specifically targeted to reduce Lp(a) levels would thereby lower the risk for ischemic cardiovascular events after ACS,” the researchers wrote.

Importantly, the study population was highly exposed to medical therapy: 97% got statins, 87% beta blockers, 80% ACE inhibitors, 97% aspirin, and 89% clopidogrel (Plavix) and other platelet P2Y12 inhibitors. In total, 89% received coronary revascularization for the index ACS event.

“In studies that specifically evaluated patients with ACS, the congruent neutral findings from the PROVE-IT trial and the present analysis suggest that prognosis is dominated by factors other than Lp(a) concentration or that any influence of Lp(a) level is nullified by the prevalent use of high-intensity statin therapy, dual antiplatelet therapy, and coronary revascularization procedures,” Schwartz’s group said.

“Moreover, the corresponding findings from the PROVE-IT trial (with Lp[a] levels measured approximately 1 week after ACS) and from the present analysis (with the Lp[a] level measured 4 to 12 weeks after ACS) suggest that acute-phase effects on Lp(a) levels are unlikely to influence any association of Lp(a) level with cardiovascular outcomes; instead, the composite of the data on ACS indicate that no such association exists.”

The investigators conceded that perhaps PCSK9 inhibitors and other therapies may reduce Lp(a) concentrations to the point that they also meaningfully reduce the risk of ischemic cardiovascular events after ACS.

Lp(a), a transporter of cholesterol and triglycerides in the bloodstream, is thought to promote atherosclerosis and thrombosis.

Schwartz and colleagues performed an ad hoc analysis of the dal-Outcomes trial, which randomized patients to the cholesteryl ester transfer protein inhibitor dalcetrapib or placebo beginning 4 to 12 weeks after ACS. They measured Lp(a) in serum samples after ACS and again at 3 months by immunoturbidimetric assay.

By the end of follow-up, there were 969 case patients (those who experienced a primary cardiovascular outcome) and 3,170 randomly-matched control patients (those who were event-free after experiencing the index ACS). Participants were mostly white men.

“Its limitations include the possibility that the analysis was underpowered to detect an association of Lp(a) level with cardiovascular outcomes restricted to the upper range of Lp(a) concentrations,” the authors said of their study.

“Other limitations are those inherent to case-cohort studies, which are subject to confounding because only a subset of the entire trial cohort had biomarker measurements. Matching and covariate adjustments were used to account for the most likely confounders, but potential confounding by other unmeasured covariates cannot be excluded,” they acknowledged.

Schwartz disclosed institutional support from Cerenis, The Medicines Company, Resverlogix, Roche, and Sanofi.

2017-10-26T11:00:00-0400

Tagged with:

About author

Related Articles