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High-Sensitivity C-Reactive Protein Modifies the Cardiovascular Risk of Lipoprotein(a): Multi-Ethnic Study

Wei Zhang1, Jaime Lynn Speiser2, Fan Ye1

  • 1Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA.

Journal of the American College of Cardiology
|September 10, 2021
PubMed

Insights

Elevated lipoprotein (a) [Lp(a)] increases atherosclerotic cardiovascular disease (ASCVD) risk only when high-sensitivity C-reactive protein (hsCRP) is also high. Combined elevations indicate greater ASCVD and mortality risk, warranting closer monitoring.

Area of Science:

  • Cardiovascular Medicine
  • Biomarkers and Risk Stratification
  • Atherosclerosis Research

Background:

  • The relationship between lipoprotein (a) [Lp(a)] and high-sensitivity C-reactive protein (hsCRP) and their combined impact on atherosclerotic cardiovascular disease (ASCVD) is not well understood.
  • Understanding these interactions is crucial for refining risk assessment and preventive strategies for cardiovascular disease (CVD).

Purpose of the Study:

  • To investigate whether the ASCVD risk associated with Lp(a) is modified by the presence of hsCRP.
  • To assess the joint association of Lp(a) and hsCRP with cardiovascular events in individuals undergoing primary prevention.

Main Methods:

  • Analysis of 4,679 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) Apolipoprotein ancillary dataset.
  • Utilized Cox proportional hazards models and Kaplan-Meier curves to evaluate the associations between Lp(a), hsCRP, and CVD event occurrence.
  • Assessed interactions between Lp(a) and hsCRP levels over a mean follow-up of 13.6 years.

Main Results:

  • A significant interaction between Lp(a) and hsCRP was observed (P = 0.04).
  • Elevated Lp(a) conferred significant CVD risk only when hsCRP levels were ≥2 mg/L.
  • Concomitant elevations of Lp(a) (≥50 mg/dL) and hsCRP (≥2 mg/L) were independently associated with increased ASCVD risk (HR: 1.62) and all-cause mortality (HR: 1.39).

Conclusions:

  • Lp(a)-associated ASCVD risk is contingent upon the presence of elevated hsCRP, indicating systemic inflammation.
  • Individuals with both elevated Lp(a) and hsCRP face a substantially higher risk of ASCVD and all-cause mortality.
  • These findings suggest that combined Lp(a) and hsCRP elevation may identify a high-risk group meriting intensified surveillance and management strategies.
Abstract

Keywords:
ASCVDMulti-Ethic Study of Atherosclerosis (MESA)cardiovascular riskhigh-sensitivity C-reactive protein (hsCRP)inflammationlipoprotein(a)

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