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Association of Lipoprotein(a)-Associated Mortality and the Estimated Glomerular Filtration Rate Level in Patients
Zhidong Huang1, Yanfang Yang2,3, Jin Lu2,3
1Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Insights
High lipoprotein(a) increases cardiovascular mortality risk, especially in patients with reduced estimated glomerular filtration rate (eGFR). Stratifying by eGFR reveals that elevated lipoprotein(a) poses a significant threat to those with eGFR <60 mL/min/1.73m².
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Clinical Research
Background:
- Elevated lipoprotein(a) is a known risk factor for cardiovascular disease.
- Renal function, measured by estimated glomerular filtration rate (eGFR), may influence lipoprotein(a) levels and associated outcomes.
- The interaction between eGFR and lipoprotein(a) on mortality risk requires further investigation.
Purpose of the Study:
- To investigate the association between lipoprotein(a) levels and all-cause mortality in patients undergoing coronary angiography.
- To determine if estimated glomerular filtration rate (eGFR) modifies the relationship between lipoprotein(a) and mortality.
- To assess the impact of eGFR stratification on lipoprotein(a)-associated mortality risk.
Main Methods:
- A cohort of 51,500 patients from the Cardiorenal ImprovemeNt (CIN) study was analyzed.
- Patients were stratified by lipoprotein(a) quartiles and eGFR categories (<60 and ≥60 mL/min/1.73m²).
- Cox regression models were employed to calculate hazard ratios for mortality.
Main Results:
- Higher lipoprotein(a) levels (Q2-Q4) were associated with a 10% increased adjusted risk of death overall.
- This association was significantly stronger in patients with eGFR <60 mL/min/1.73m², showing a 23% increased risk.
- No significant association between elevated lipoprotein(a) and mortality was observed in patients with eGFR ≥60 mL/min/1.73m² (P for interaction = 0.019).
Conclusions:
- Elevated lipoprotein(a) is linked to increased all-cause mortality in coronary angiography patients.
- The risk of all-cause mortality associated with elevated lipoprotein(a) is significantly modified by baseline eGFR.
- Patients with reduced eGFR and elevated lipoprotein(a) require closer monitoring and consideration for targeted interventions.
Abstract:
Background: High lipoprotein(a) is associated with poor prognosis in patients at high risk for cardiovascular disease. Renal function based on the estimated glomerular filtration rate (eGFR) is a potential risk factor for the change of lipoprotein(a). However, the regulatory effect of eGFR stratification on lipoprotein(a)-associated mortality has not been adequately addressed. Methods: 51,500 patients who underwent coronary angiography (CAG) or percutaneous coronary intervention (PCI) were included from the Cardiorenal ImprovemeNt (CIN) study (ClinicalTrials.gov NCT04407936). These patients were grouped according to lipoprotein(a) quartiles (Q1-Q4) stratified by eGFR categories (<60 and ≥60 mL/min/1.73m2). Cox regression models were used to estimate hazard ratios (HR) for mortality across combined eGFR and lipoprotein(a) categories. Results: The mean age of the study population was 62.3 ± 10.6 years, 31.3% were female (n = 16,112). During a median follow-up of 5.0 years (interquartile range: 3.0-7.6 years), 13.0% (n = 6,695) of patients died. Compared with lipoprotein(a) Q1, lipoprotein(a) Q2-Q4 was associated with 10% increased adjusted risk of death in all patients (HR: 1.10 [95% CI: 1.03-1.17]), and was strongly associated with about 23% increased adjusted risk of death in patients with eGFR <60 mL/min/1.73m2 (HR: 1.23 [95% CI: 1.08-1.39]), while such association was not significant in patients with eGFR ≥60 mL/min/1.73m2 (HR: 1.05 [95% CI: 0.97-1.13]). P for interaction between lipoprotein(a) (Q1 vs. Q2-Q4) and eGFR (≥60 vs. eGFR <60 mL/min/1.73m2) on all-cause mortality was 0.019. Conclusions: Elevated lipoprotein(a) was associated with increased risk of all-cause mortality and such an association was modified by the baseline eGFR in CAG patients. More attention should be paid to the patients with reduced eGFR and elevated lipoprotein(a), and the appropriate lipoprotein(a) intervention is required.
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