Netherlands: Results from a pilot study published in the journal Atherosclerosis showed that in patients hospitalized with COVID-19, the levels of lipoprotein(a) increase threefold during hospitalization. And, an increase in Lp(a) levels during the COVID-19 acute phase was strongly linked with venous thromboembolism (VTE) incidence. In contrast to this, the change in the inflammatory biomarkers interleukin (IL)-6 and CRP was not associated with VTE incidence.
In patients with Coronavirus disease 2019 (COVID-19), thrombosis is shown to be a major driver of mortality and adverse outcomes. Hypercoagulability may be related to the cytokine storm associated with COVID-19, which is driven mainly by IL-6. An increase in Lp(a) levels following IL-6 upregulation and Lp(a) has anti-fibrinolytic properties.
Against the above background, Erik S.G. Stroes, University of Amsterdam, Amsterdam, the Netherlands, and colleagues aimed to investigate whether Lp(a) elevation may contribute to the pro-thrombotic state hallmarking COVID-19 patients.
For this purpose, the researchers measured Lp(a), IL-6, and C-reactive protein (CRP) levels in 219 hospitalized patients with COVID-19. The baseline biomarkers and increases during admission were related to VTE incidence and clinical outcomes.
Based on the study, the researchers found the following:
· Lp(a) levels increased significantly by a mean of 16.9 mg/dl in patients with COVID-19 during the first 21 days after admission.
· Serial Lp(a) measurements were available in 146 patients.
· In the top tertile of Lp(a) increase, 56.2% of COVID-19 patients experienced a VTE event compared to 18.4% in the lowest tertile (RR 3.06).
· This association remained significant after adjusting for age, sex, IL-6 and CRP increase, and a number of measurements.
· Increases in IL-6 and CRP were not associated with VTE. Increase in Lp(a) was strongly correlated with increase in IL-6 (r = 0.44).
To conclude, increases in Lp(a) levels during the acute phase of COVID-19 were strongly associated with VTE incidence. The acute increase in anti-fibrinolytic Lp(a) may tilt the balance to VTE in patients hospitalized for COVID-19.
Reference:
The study titled, "Lipoprotein(a), venous thromboembolism and COVID-19: A pilot study," was published in the journal Atherosclerosis.
DOI: https://doi.org/10.1016/j.atherosclerosis.2021.12.008