Impact of Lipoprotein(a) Levels on Perioperative Outcomes in Cardiac Surgery

Altered lipid metabolism has been shown to be of major importance in a range of metabolic diseases, with particular importance in cardiovascular disease (CVD). As a key metabolic product, altered lipoprotein(a) (Lp(a)) levels may be associated with adverse clinical outcomes in high-risk cardiovascul...

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Autores principales:	Paul Philipp Heinisch, Maks Mihalj, Markus Huber, Joerg C. Schefold, Alexander Hartmann, Michael Walter, Elisabeth Steinhagen-Thiessen, Juerg Schmidli, Frank Stüber, Lorenz Räber, Markus M Luedi
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	cardiovascular disease lipoprotein(a) cardiac surgery cardiopulmonary bypass Biology (General) QH301-705.5
Acceso en línea:	https://doaj.org/article/0bbae8cd35a545d0b32f4a592c15dd74
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spelling	oai:doaj.org-article:0bbae8cd35a545d0b32f4a592c15dd742021-11-25T17:07:40ZImpact of Lipoprotein(a) Levels on Perioperative Outcomes in Cardiac Surgery10.3390/cells101128292073-4409https://doaj.org/article/0bbae8cd35a545d0b32f4a592c15dd742021-10-01T00:00:00Zhttps://www.mdpi.com/2073-4409/10/11/2829https://doaj.org/toc/2073-4409Altered lipid metabolism has been shown to be of major importance in a range of metabolic diseases, with particular importance in cardiovascular disease (CVD). As a key metabolic product, altered lipoprotein(a) (Lp(a)) levels may be associated with adverse clinical outcomes in high-risk cardiovascular patients undergoing cardiac surgery. We aimed to investigate the impact of the important metabolite Lp(a) on complications and clinical outcomes in high-risk patients. A prospective observational cohort study was performed. Data were derived from the Bern Perioperative Biobank (ClinicalTrials.gov NCT04767685), and included 192 adult patients undergoing elective cardiac surgery. Blood samples were collected at 24 h preoperatively, before induction of general anaesthesia, upon weaning from cardiopulmonary bypass (CPB), and the first morning after surgery. Clinical endpoints included stroke, myocardial infarction, and mortality within 30 days after surgery or within 1 year. Patients were grouped according to their preoperative Lp(a) levels: <30 mg/dL (<i>n</i> = 121; 63%) or >30 mg/dL (<i>n =</i> 71, 37%). The groups with increased vs. normal Lp(a) levels were comparable with regard to preoperative demographics and comorbidities. Median age was 67 years (interquartile range (IQR) 60.0, 73.0), with median body mass index (BMI) of 23.1 kg/m<sup>2</sup> (23.7, 30.4), and the majority of patients being males (75.5%). Over the observational interval, Lp(a) levels decreased in all types of cardiac surgery after CPB (mean decline of approximately −5 mg/dL). While Lp(a) levels decreased in all patients following CPB, this observation was considerably pronounced in patients undergoing deep hypothermic circulatory arrest (DHCA) (decrease to preoperative Lp(a) levels by −35% (95% CI −68, −1.7), <i>p</i> = 0.039). Increased Lp(a) levels were neither associated with increased rates of perioperative stroke or major adverse events in patients undergoing cardiac surgery, nor with overall mortality in the perioperative period, or at one year after surgery. Other than for cohorts in neurology and cardiology, elevated Lp(a) might not be a risk factor for perioperative events in cardiac surgery.Paul Philipp HeinischMaks MihaljMarkus HuberJoerg C. SchefoldAlexander HartmannMichael WalterElisabeth Steinhagen-ThiessenJuerg SchmidliFrank StüberLorenz RäberMarkus M LuediMDPI AGarticlecardiovascular diseaselipoprotein(a)cardiac surgerycardiopulmonary bypassBiology (General)QH301-705.5ENCells, Vol 10, Iss 2829, p 2829 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	cardiovascular disease lipoprotein(a) cardiac surgery cardiopulmonary bypass Biology (General) QH301-705.5
spellingShingle	cardiovascular disease lipoprotein(a) cardiac surgery cardiopulmonary bypass Biology (General) QH301-705.5 Paul Philipp Heinisch Maks Mihalj Markus Huber Joerg C. Schefold Alexander Hartmann Michael Walter Elisabeth Steinhagen-Thiessen Juerg Schmidli Frank Stüber Lorenz Räber Markus M Luedi Impact of Lipoprotein(a) Levels on Perioperative Outcomes in Cardiac Surgery
description	Altered lipid metabolism has been shown to be of major importance in a range of metabolic diseases, with particular importance in cardiovascular disease (CVD). As a key metabolic product, altered lipoprotein(a) (Lp(a)) levels may be associated with adverse clinical outcomes in high-risk cardiovascular patients undergoing cardiac surgery. We aimed to investigate the impact of the important metabolite Lp(a) on complications and clinical outcomes in high-risk patients. A prospective observational cohort study was performed. Data were derived from the Bern Perioperative Biobank (ClinicalTrials.gov NCT04767685), and included 192 adult patients undergoing elective cardiac surgery. Blood samples were collected at 24 h preoperatively, before induction of general anaesthesia, upon weaning from cardiopulmonary bypass (CPB), and the first morning after surgery. Clinical endpoints included stroke, myocardial infarction, and mortality within 30 days after surgery or within 1 year. Patients were grouped according to their preoperative Lp(a) levels: <30 mg/dL (<i>n</i> = 121; 63%) or >30 mg/dL (<i>n =</i> 71, 37%). The groups with increased vs. normal Lp(a) levels were comparable with regard to preoperative demographics and comorbidities. Median age was 67 years (interquartile range (IQR) 60.0, 73.0), with median body mass index (BMI) of 23.1 kg/m<sup>2</sup> (23.7, 30.4), and the majority of patients being males (75.5%). Over the observational interval, Lp(a) levels decreased in all types of cardiac surgery after CPB (mean decline of approximately −5 mg/dL). While Lp(a) levels decreased in all patients following CPB, this observation was considerably pronounced in patients undergoing deep hypothermic circulatory arrest (DHCA) (decrease to preoperative Lp(a) levels by −35% (95% CI −68, −1.7), <i>p</i> = 0.039). Increased Lp(a) levels were neither associated with increased rates of perioperative stroke or major adverse events in patients undergoing cardiac surgery, nor with overall mortality in the perioperative period, or at one year after surgery. Other than for cohorts in neurology and cardiology, elevated Lp(a) might not be a risk factor for perioperative events in cardiac surgery.
format	article
author	Paul Philipp Heinisch Maks Mihalj Markus Huber Joerg C. Schefold Alexander Hartmann Michael Walter Elisabeth Steinhagen-Thiessen Juerg Schmidli Frank Stüber Lorenz Räber Markus M Luedi
author_facet	Paul Philipp Heinisch Maks Mihalj Markus Huber Joerg C. Schefold Alexander Hartmann Michael Walter Elisabeth Steinhagen-Thiessen Juerg Schmidli Frank Stüber Lorenz Räber Markus M Luedi
author_sort	Paul Philipp Heinisch
title	Impact of Lipoprotein(a) Levels on Perioperative Outcomes in Cardiac Surgery
title_short	Impact of Lipoprotein(a) Levels on Perioperative Outcomes in Cardiac Surgery
title_full	Impact of Lipoprotein(a) Levels on Perioperative Outcomes in Cardiac Surgery
title_fullStr	Impact of Lipoprotein(a) Levels on Perioperative Outcomes in Cardiac Surgery
title_full_unstemmed	Impact of Lipoprotein(a) Levels on Perioperative Outcomes in Cardiac Surgery
title_sort	impact of lipoprotein(a) levels on perioperative outcomes in cardiac surgery
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/0bbae8cd35a545d0b32f4a592c15dd74
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Impact of Lipoprotein(a) Levels on Perioperative Outcomes in Cardiac Surgery

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