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Association of lipoprotein(a) with all-cause and cause-specific mortality: A prospective cohort study
Zhen-Wei Wang1, Min Li1, Jing-Jie Li2
1Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
Insights
Elevated lipoprotein(a) [Lp(a)] levels are linked to increased risks of all-cause and cardiovascular disease (CVD) mortality. This association remained significant even after adjusting for traditional cardiovascular risk factors.
Area of Science:
- Cardiovascular Medicine
- Epidemiology
- Biomarkers
Background:
- Lipoprotein(a) [Lp(a)] is increasingly recognized for its causal role in atherosclerotic cardiovascular diseases (ASCVDs).
- The relationship between Lp(a) levels and overall or cause-specific mortality is not well-established.
- ASCVDs represent a significant global health burden, necessitating further research into risk factors like Lp(a).
Purpose of the Study:
- To investigate the association between lipoprotein(a) [Lp(a)] levels and all-cause mortality.
- To examine the association between Lp(a) and cause-specific mortality, particularly cardiovascular disease (CVD)-related mortality.
- To clarify the prognostic value of Lp(a) beyond traditional cardiovascular risk factors.
Main Methods:
- Prospective cohort study utilizing data from 8,525 participants in the third National Health and Nutrition Examination Survey.
- Lipoprotein(a) [Lp(a)] levels served as the exposure variable, with all-cause and cause-specific mortality as outcomes.
- COX proportional hazards regression, stratified analyses, sensitivity analyses, and survival curves were employed to assess associations.
Main Results:
- After adjusting for cardiovascular risk factors, Lp(a) showed a significant association with all-cause mortality (P for trend = 0.007) and CVD-related mortality (P < 0.001).
- Subgroup analyses indicated that higher Lp(a) was associated with increased all-cause mortality risk in individuals over 60, with BMI < 30 kg/m², and without diabetes.
- The association between Lp(a) and CVD-related mortality was consistent across various subgroups, including younger individuals, males, those with hypertension, and those without prior CVDs.
Conclusions:
- Lipoprotein(a) [Lp(a)] is a significant independent risk factor associated with both all-cause and cardiovascular disease (CVD)-related mortality.
- The findings highlight the importance of considering Lp(a) levels in cardiovascular risk assessment and patient management.
- Further research may explore therapeutic strategies targeting Lp(a) to mitigate mortality risk.
Background:
A growing number of studies have demonstrated a causal association between lipoprotein(a) [Lp(a)] and atherosclerotic cardiovascular diseases (ASCVDs), but its association with all-cause and cause-specific mortality remains unclear. Therefore, this study aimed to explore the association of Lp(a) with all-cause and cause-specific mortality.
Methods:
This prospective cohort study included 8,525 participants from the third National Health and Nutrition Examination Survey. Lp(a) was considered an exposure variable, all-cause and cause-specific mortality were used as outcome variables, and all participants were followed from the interview date until death or December 31, 2015. COX proportional hazards regression models, stratified analysis, sensitivity analysis, restricted cubic spline plots and Kaplan-Meier survival curves were used to analyze the association of Lp(a) with all-cause and cause-specific mortality.
Results:
After adjusting for traditional cardiovascular risk factors, Lp(a) remained strongly associated with all-cause and CVDs-related mortality (P for trend = 0.007 and < 0.001). Subgroup analyses showed that higher Lp(a) remained associated with higher risk of all-cause mortality in those > 60 years of age, with a BMI < 30 kg/m2, and without diabetes, whereas the association between Lp(a) and CVDs-related mortality remained stable in participants ≤ 60 years of age, male, with a BMI < 30 kg/m2, with hypertension, without diabetes, or without CVDs (P < 0.05). In sensitivity analyses, we found that the association of Lp(a) with all-cause and CVDs-related mortality remained robust after excluding individuals who died within one year of follow-up (P for trend = 0.041 and 0.002).
Conclusions:
Lp(a) was associated with the risk of all-cause and CVDs-related mortality.
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