Evidence map›Paper›PMID 40401600›Full record

Trial reportJournal of the American Heart Association2025

Association of Lipoprotein(a) With Major Adverse Limb Events and All-Cause Mortality Following Revascularization for Chronic Limb-Threatening Ischemia: A Substudy of the BEST-CLI Trial.

Alexander E Sullivan, Shi Huang, Suman Kundu, Victoria E Thomas, Daniel G Clair, Aaron W Aday, Matthew T Menard, Alik Farber, Kenneth Rosenfield, Jonathan D Newman and 5 more

Registry-linked trialAbstract readEquivalence TrialMulticenter StudyPragmatic Clinical Trial
In one paragraph

Trial report in Journal of the American Heart Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03085524 (The Impact of Diabetes on REvascularization), which is not on this map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03085524 completednot on this map

The Impact of Diabetes on REvascularization

TypeobservationalSponsorVanderbilt University Medical CenterRan2017 to 2022Enrolled215ConditionsPeripheral Arterial Disease, Diabetes MellitusArmsPlatelet function testing, Vascular ultrasonography
3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Alexander E SullivanDivision of Cardiovascular Medicine, Department of Medicine Vanderbilt University Medical Center Nashville TN USA.ORCID 0000-0002-1755-0055
Shi HuangDepartment of Biostatistics Vanderbilt University School of Medicine Nashville TN USA.
Suman KunduDivision of Cardiovascular Medicine, Department of Medicine Vanderbilt University Medical Center Nashville TN USA.ORCID 0000-0002-6305-2559
Victoria E ThomasDivision of Cardiovascular Medicine, Department of Medicine Vanderbilt University Medical Center Nashville TN USA.ORCID 0000-0001-7814-8361
Daniel G ClairDepartment of Vascular Surgery Vanderbilt University Medical Center Nashville TN USA.ORCID 0000-0002-6269-260X
Aaron W AdayDivision of Cardiovascular Medicine, Department of Medicine Vanderbilt University Medical Center Nashville TN USA.ORCID 0000-0001-6243-3432
Matthew T MenardDivision of Vascular and Endovascular Surgery, Brigham and Women's Hospital Harvard Medical School Boston MA USA.ORCID 0000-0003-2470-7978
Alik FarberDepartment of Surgery, Division of Vascular and Endovascular Surgery, Boston Medical Center Boston University Chobanian & Avedisian School of Medicine Boston MA USA.ORCID 0000-0001-7231-4189
Kenneth RosenfieldSection of Vascular Medicine and Intervention, Massachusetts General Hospital Harvard Medical School Boston MA USA.ORCID 0000-0002-5633-6983
Jonathan D NewmanDepartment of Medicine NYU Grossman School of Medicine New York NY USA.ORCID 0000-0001-6855-7305
Jeffrey S BergerDepartment of Medicine NYU Grossman School of Medicine New York NY USA.ORCID 0000-0001-8216-4647
Quinn S WellsDivision of Cardiovascular Medicine, Department of Medicine Vanderbilt University Medical Center Nashville TN USA.ORCID 0000-0003-3899-0313
Matthew S FreibergDivision of Cardiovascular Medicine, Department of Medicine Vanderbilt University Medical Center Nashville TN USA.ORCID 0000-0002-3699-4022
MacRae F LintonDivision of Cardiovascular Medicine, Department of Medicine Vanderbilt University Medical Center Nashville TN USA.ORCID 0000-0002-9277-0453
Joshua A BeckmanDivision of Vascular Medicine, Department of Medicine University of Texas Southwestern Dallas TX USA.ORCID 0000-0001-8332-8439

Funding

Non-coding RNA & Bioinformatics CoreP01HL116263 · NHLBI · VANDERBILT UNIVERSITY MEDICAL CENTER · PI DAVIES, SEAN STEPHEN · 2014 to 2025
$24.7M
CLINICAL PHARMACOLOGY TRAINING PROGRAMT32GM007569 · NIGMS · VANDERBILT UNIVERSITY MEDICAL CENTER · PI Bjorn C Knollmann · 1985 to 2026
$12.4M
The Impact of Diabetes on Revascularization in BEST-CLIR01HL131977 · NHLBI · VANDERBILT UNIVERSITY MEDICAL CENTER · PI ADAY, AARON W., BECKMAN, JOSHUA A · 2016 to 2020
$4.0M
Molecular predictors of cardiovascular events and resilience in chronic coronary artery diseaseR01HL165208 · NHLBI · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · PI JONATHAN D NEWMAN, Kelly Valentine Ruggles · 2023 to 2026
$3.0M
NHLBI NIH HHS P01 HL116263NHLBI NIH HHS R01 HL131977NHLBI NIH HHS R01 HL165208NIGMS NIH HHS T32 GM007569
6 · The paper itself

Abstract

backgroundThe BEST-CLI (Best Endovascular Versus Best Surgical Therapy in Patients With Critical Limb Ischemia) trial tested the optimal initial revascularization strategy in patients with chronic limb-threatening ischemia. Little is known about the prognostic relevance of Lp(a) (lipoprotein[a]) and its modification by renal function in patients with chronic limb-threatening ischemia. We investigated the relationship between Lp(a) and prespecified cardiovascular outcomes.

methodsA subgroup of patients from the BEST-CLI trial (as part of the TIDE [The Impact of Diabetes on Revascularization] study) underwent blinded, core-laboratory assessment of Lp(a) levels and were included in this analysis. The primary end point was major adverse limb events or death from any cause. Secondary end points were the components of the primary end point, major amputation, major reintervention, and major adverse cardiac events (myocardial infarction, ischemic stroke, or death from any cause). The association of Lp(a) with end points was assessed using Cox proportional hazard models adjusting for traditional risk factors and then also for renal function and statin use, which increase Lp(a) levels.

resultsA total of 189 patients (median [interquartile range] age 67.3 [61.6-74.1] years) were included and followed for a median of 2.1 (1.2-2.9) years. Median Lp(a) for the total study population was 27.3 (10.4-65.8) mg/dL, and 62 (32.8%) patients had elevated values (≥50 mg/dL). The 1-year event rate of the primary outcome was 33.3 (95% CI, 23.7-42.8) per 100 person-years. There was no association between Lp(a) and the primary outcome (hazard ratio [HR], 1.00 [95% CI, 0.99-1.00];

conclusionsElevated Lp(a) level was not associated with major adverse limb events or death but was associated with all-cause death after controlling for renal function. Lp(a) may be an important therapeutic target in the patient population with high-risk chronic limb-threatening ischemia. REGISTRATION: https://clinicaltrials.gov/study/NCT03085524; Unique identifier: NCT03085524.

Indexed as

Chronic Limb-Threatening IschemiaEndovascular ProceduresIschemiaLipoprotein(a)Peripheral Arterial DiseaseVascular Surgical ProceduresAgedAmputation, SurgicalBiomarkersCause of DeathChronic DiseaseFemaleHumansLimb SalvageMaleMiddle AgedBiomarkersLipoprotein(a)LPA protein, humanchronic limb‐threatening ischemialipidslipoprotein(a)mortalityperipheral artery disease

Identifiers

PMID40401600
PMCPMC12229200

What Socratic holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.