Physicians' Academy for Cardiovascular Education

Elevated sLOX-1 levels in ACS patients predict fatal events at 1 year

Soluble lectin-like oxidized low-density lipoprotein receptor-1 predicts premature death in acute coronary syndromes

Literature - Kraler S, Wenzl FA, Georgiopoulos G, et al. - Eur Heart J. 2022;

Introduction and methods


Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) is expressed by atherosclerotic plaques and has been suggested to play an important role in the pathogenesis of atherosclerotic cardiovascular disease (ASCVD) [1-3]. Pro-inflammatory conditions in the atherosclerotic plaque simulate LOX-1 cleavage and in turn, its shedding product, soluble LOX-1 (sLOX-1) is emerging as a novel biomarker which reflects plaque burden and vulnerability [4,5]. Previous studies have shown that elevated sLOX-1 plasma levels are related to poor outcomes in stable patients during long-term follow-up [6,7].

Aim of the study

The objective of this study - known as the SPUM-ACS-study – was to study the relationship of sLOX-1 with mortality from any cause at 30 days and 1 year, the interplay of sLOX-1 with hs-CRP on risk of death from any or CV causes and the association of temporal changes of sLOX-1 with plaque progression in patients with ACS.


The SPUM-ACS study was an investigator-driven, multicentre prospective cohort study [8-11]. Between January 2010 and January 2019, a total of 2747 patients with ACS (n=2639) and chronic coronary syndrome (CCS; n=69) were included in the study as well as sex- and age-matched healthy controls (CTRL; n=120).

In a subcohort of ACS patients, longitudinal sLOX-1 measurements and serial intracoronary intravascular ultrasound (IVUS) at baseline and 1 year follow-up were performed.

Main results


This study showed that sLOX-1 plasma levels are increased during ACS, particularly in patients with STEMI, predicting fatal events at 1 year beyond both traditional and established risk factors as well as GRACE 2.0. Persistently high plasma levels of sLOX-1 after ACS associate with coronary plaque progression in patients receiving lipid-lowering therapy. Thus, sLOX-1 has shown to be a novel and independent biomarker for fatal events in patients presenting with ACS.


Show references

Find this article online at Eur Heart J.

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