Evidence mapPaperPMID 40640828Full record

Observational studyCardiovascular diabetology2025

Prognostic value of lipoprotein(a) for cardiovascular events after lower limb revascularization in diabetic patients with chronic limb-threatening ischemia.

Federico Biscetti, Maria Margherita Rando, Maria Anna Nicolazzi, Flavia Angelini, Roberto Iezzi, Luis H Eraso, Paul J Dimuzio, Dario Pitocco, Massimo Massetti, Antonio Gasbarrini and 1 more

Abstract readObservational Study
In one paragraph

Observational study in Cardiovascular diabetology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing 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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Observational
  2. Article
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

11 authors.

Federico Biscetti *Cardiovascular Internal Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy. f.biscetti@gmail.com.
Maria Margherita Rando *Cardiovascular Internal Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
Maria Anna NicolazziCardiovascular Internal Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.
Flavia AngeliniUniversità Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy.
Roberto IezziUniversità Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy.
Luis H ErasoDivision of Vascular and Endovascular Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Paul J DimuzioDivision of Vascular and Endovascular Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Dario PitoccoUniversità Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy.
Massimo MassettiUniversità Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy.
Antonio GasbarriniUniversità Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy.
Andrea FlexCardiovascular Internal Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundChronic limb-threatening ischemia (CLTI) presents a major clinical challenge in patients with Type 2 Diabetes Mellitus (T2DM), requiring lower extremity revascularization (LER) to mitigate adverse cardiovascular and limb outcomes. Lipoprotein(a) (Lp(a)) has been implicated in cardiovascular risk, but its role in patients with T2DM and CLTI undergoing revascularization remains unclear. Thus, this study aimed to investigate the prognostic value of Lp(a) levels in diabetic CLTI patients for major adverse cardiovascular events (MACE), major adverse limb events (MALE), or both after LER.

methodsIn this prospective cohort study of 158 individuals with T2DM and CLTI undergoing LER, baseline clinical data were collected, including Lp(a) levels. Patients were followed for occurrence of MACE, MALE, or both over a 12-month period.

resultsDuring follow-up, 74 patients (46.8%) experienced events (MACE, MALE, or both). Patients with events had significantly higher median Lp(a) levels than those without (48.0 vs. 8.1 mg/dL, p < 0.01). Lp(a) was independently associated with adverse events (HR 1.07, 95% CI 1.04-1.10; p < 0.01). In multivariable analysis, elevated Lp(a) was independently associated with both MACE (HR 1.08, 95% CI 1.03-1.13; p < 0.01) and MALE (HR 1.05, 95% CI 1.02-1.07; p < 0.01). An empirical Lp(a) cutoff of 29.6 mg/dL conferred a 3.8-fold increased risk of events (p < 0.01). Kaplan-Meier survival analysis further confirmed a significantly higher cumulative incidence of events in patients with Lp(a) levels above cutoff (p < 0.01). ROC curve comparison analysis showed that the inclusion of Lp(a) significantly improved the predictive performance of the base clinical model (AUC from 0.74 to 0.98, p < 0.01 for composite outcome; from 0.81 to 0.89, p = 0.03 for MACE; and from 0.78 to 0.92, p < 0.01for MALE).

conclusionsThis study demonstrated that Lp(a) is a strong independent predictor of both cardiovascular and limb events in patients with T2DM undergoing LER for CLTI. These findings support the potential role of Lp(a) as a marker of residual risk in this high-risk population and suggest its utility in risk stratification.

Indexed as

Diabetes Mellitus, Type 2Endovascular ProceduresIschemiaLipoprotein(a)Lower ExtremityPeripheral Arterial DiseaseVascular Surgical ProceduresAgedBiomarkersChronic DiseaseFemaleHumansMaleMiddle AgedPredictive Value of TestsProspective StudiesBiomarkersLipoprotein(a)LPA protein, humanLipoprotein(a) (Lp(a))Major adverse cardiovascular events (MACE)Major adverse limb events (MALE)Peripheral artery disease (PAD)

Identifiers

PMID40640828
PMCPMC12243197

What Socratic holds

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LicenceCC BY-NC-ND
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Registered trials

None linked

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.