Mekke_2023_Eur.J.Vasc.Endovasc.Surg__

INTRODUCTION: Carotid plaque intraplaque haemorrhage (IPH) is associated with future cardiovascular events. It was hypothesised that plasma proteins associated with carotid plaque IPH are also likely to be associated with major adverse cardiovascular events (MACE) after carotid endarterectomy (CEA). METHODS: In pre-operative blood samples from patients undergoing CEA within the Athero-Express biobank, proteins involved in cardiovascular disease were measured using three OLINK proteomics immunoassays. The association of proteins with IPH was analysed using logistic regression analyses. Subsequently, the association of the IPH associated plasma proteins with the three year post-operative risk of MACE (including stroke, myocardial infarction, or cardiovascular death) was analysed. RESULTS: Within the three year follow up, 130 patients (18.9%) out of 688 symptomatic and asymptomatic patients undergoing CEA developed MACE. Six out of 276 plasma proteins were found to be significantly associated with IPH, from which only lipoprotein lipase (LPL) was associated with the post-operative risk of MACE undergoing CEA. Within the 30 day peri-operative period, high plasma LPL was independently associated with an increased risk for MACE (adjusted hazard ratio [HR] per standard deviation [SD] 1.60, 1.10 - 2.30), p = .014). From 30 days up to three years, however, high LPL was associated with a lower risk for MACE (adjusted HR per SD 0.80, 0.65 - 0.99, p = .036). CONCLUSION: High LPL concentrations were found to be associated with a higher risk for MACE in the first 30 post-operative days but associated with a lower risk MACE in the time period from 30 days to three years, meaning that LPL has different hazards at different time points.