Researchers are continually searching for valid and reliable biomarkers in the quest to predict coronary artery disease (CAD). More sensitive biomarkers may facilitate the earlier identification of damaged or diseased tissue, allowing for earlier intervention and mitigation.
The Catheter Sampled Blood Archive in Cardiovascular Diseases (CASABLANCA) study (NCT00842868) explored the relationship between new and experimental biomarkers and CAD.
Lipoprotein(a) (Lp[a]) and oxidized phospholipids (OxPLs) are known independent risk factors for atherosclerotic heart disease. In a recent study, researchers explored the extent to which Lp(a) and OxPLs could predict severity and outcomes in CAD.
Investigators measured Lp(a), OxPL associated apolipoprotein B (OxPL-apoB) and OxPL-associated apolipoprotein(a) (OxPL-apo[a]) levels in 1098 trial participants undergoing coronary angiography. Next they used logistic regression to estimate the risk of multivessel coronary stenoses by Lp(a)-related biomarker level. They also used Cox proportional hazards regression to estimate the risk of major adverse cardiovascular events (MACEs) (coronary revascularization, nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death) in follow-up.
Predictive relationship identified
Interestingly, researchers found that each biomarker was associated with cardiovascular events. Specifically, Lp(a) and OxPL-apoB were associated with multivessel CAD. Odds of multivessel CAD per doubling of Lp(a), OxPL-apoB, and OxPL-apo(a) were: 1.10 (95% confidence interval [CI]:1.03-1.18, P = 0.006), 1.18 (95%CI: 1.03-1.34, P = 0.01), and 1.07 (95%CI: 0.99-1.16, P = 0.07), respectively.
Hazard ratios for MACE per doubling of Lp(a), OxPL-apoB, and OxPL-apo(a) were: 1.08 (95%CI: 1.03-1.14, P = 0.001), 1.15 (95%CI: 1.05-1.26, P = 0.004), and 1.07 (95%CI: 1.01-1.14, P = 0.02), respectively.
Researchers highlighted CASABLANCA’s findings that in patients who underwent coronary angiography, Lp(a) and OxPLs associated with apoB and apo(a) were highly correlated and associated with the presence of severe CAD. Similarly, these biomarkers are predictive of subsequent MACE. The authors recommended that future research should explore if Lp(a)-lowering therapies lower the risk of CAD and MACE.
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Author: Kelly Schoonderwoerd
Original Article: Gilliland TC et al. JACC. 2023;81(18):1780-1792.
