Title : Association of lipoprotein (a) with clinical adverse outcomes in patients with concurrentpsoriasis and coronary artery disease
Background: Elevated Lp(a) levels are proven as a marker of increased risk of cardiovascular disease. Also,the evidence indicates that patients with psoriasis are at an increased risk of cardiovascular disease.However, as so far, it is not clear whether increased Lp(a) will cause differences on clinical outcomesofpsoriatic patients who have already suffered from coronary artery disease.
Methods: This is a retrospective cohort study, including consecutive psoriatic patients withcoronaryartery disease between January 2017 and May 2022 in our hospital. The clinical records werecollected,and comparisons were made between patients in low Lp(a) and high Lp(a) groups. Survival curveswerederived using Kaplan-Meier methods and log-rank tests were used to compare them. Subgroupanalysisofthe clinical endpoints was performed based on the following factors, including age, sex, diabetes,hypertension, chronic kidney disease and clinical presentation.
Results: Among 295 patients included in the study, 148 patients were in the lowLp(a) groupand147patients were in the high Lp(a) group. There were no significant differences in age, sex, andBMI, theproportions of hypertension and diabetes between the two groups. The levels of white bloodcounts(p=0.026), platelet counts (p = 0.038), uric acid(p = 0.019) and hsCRP (p = 0.012) were higher inthehighLp(a)group than those in the low LP(a) group. Participants in the high Lp(a) group had higher TClevels(p=0.029) and higher triglycerides levels (p = 0.027). The left ventricular ejection fraction was lowerinthehigh Lp(a) group (p=0.019). Patients in the high Lp(a) group were more likely to have right coronaryarteryinvolvement (p = 0.039). Kaplan-Meier survival curves showed that among patients withdiabetes, therewas a statistically significant difference in all-cause death (log rank p = 0.036) and re-hospitalization(logrank p = 0.027) between the two group; the difference of re-hospitalization (log rank p = 0.042) wasalsofound between the two groups among male patients.
Conclusion: Elevated Lp(a) levels were associated with the right coronary artery diseaseandpositivelyrelated to the higher risk of all cause death and re-hospitalization in patients with diabetesandmalepatients. These results will provide valuable information for improving the prognosis of psoriaticpatientsconcurrent coronary disease.
- Elevated Lp(a) levels were associated with the right coronary artery disease andpositivelyrelated to the higher risk of all cause death and re-hospitalization in patients withdiabetesand male patients.
- The results contribute to risk stratification in this subset of patients andwill provideaclearer understanding of the effect of Lp(a) on the prognosis of these patients.
- It is suggested that Lp (a) level should be closely detected in diabetic and malepsoriaticpatients concurrent with coronary artery disease, and treatment should be consideredtoavoid adverse clinical events.