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Lipoprotein(a), high-sensitivity C-reactive protein, and cardiovascular risk in patients undergoing percutaneous
Deshan Yuan1, Peizhi Wang1, Sida Jia1
1National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, PR China.
Insights
High Lipoprotein(a) (Lp(a)) levels increase cardiovascular risk in patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI). This risk is amplified when combined with elevated high-sensitivity C-reactive protein (hsCRP), aiding in identifying high-risk individuals.
Area of Science:
- Cardiovascular Medicine
- Biomarkers
- Interventional Cardiology
Background:
- Coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI) face ongoing cardiovascular risk.
- The combined impact of Lipoprotein(a) (Lp(a)) and high-sensitivity C-reactive protein (hsCRP) on this risk is not fully understood.
- Identifying specific biomarkers for risk stratification is crucial for optimizing patient management.
Purpose of the Study:
- To investigate the independent and combined associations of Lp(a) and hsCRP with major adverse cardiac and cerebrovascular events (MACCE) in CAD patients post-PCI.
- To determine if elevated hsCRP modifies the cardiovascular risk associated with high Lp(a) levels.
- To assess the utility of combined Lp(a) and hsCRP evaluation for risk stratification.
Main Methods:
- Prospective cohort study including 10,424 patients with Lp(a) and hsCRP measurements.
- Analysis using Cox proportional hazards models and Kaplan-Meier survival analysis.
- Evaluation of MACCE, defined as all-cause death, myocardial infarction, ischemic stroke, and revascularization, over 5 years.
Main Results:
- Elevated Lp(a) and hsCRP were independently associated with increased MACCE risk (p<0.05).
- A significant interaction between Lp(a) and hsCRP was observed (P for interaction = 0.019).
- The association between Lp(a) and MACCE was significantly stronger in patients with hsCRP ≥ 2 mg/L compared to those with hsCRP < 2 mg/L. Dual elevation of Lp(a) and hsCRP identified patients with the highest MACCE risk.
Conclusions:
- High Lp(a) levels are associated with worse outcomes in CAD patients undergoing PCI.
- The cardiovascular risk associated with high Lp(a) is potentiated by elevated hsCRP.
- Simultaneous assessment of Lp(a) and hsCRP can enhance identification of high-risk individuals for targeted interventions.
Background And Aims:
In patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI), the effects of high-sensitivity C-reactive protein (hsCRP) on Lipoprotein(a) (Lp(a))-associated cardiovascular risk remains unclear. This study aimed to investigate the independent and combined association of Lp(a) and hsCRP with cardiovascular events in this specific population.
Methods:
A total of 10,424 patients with measurements of both Lp(a) and hsCRP were included in this prospective cohort study. Cox proportional hazards models and Kaplan-Meier analysis were performed to evaluate the relationship between Lp(a), hsCRP and adverse cardiac and cerebrovascular events (MACCE; all-cause death, myocardial infarction, ischemic stroke and revascularization).
Results:
During 5 years of follow-up, 2140 (20.5%) MACCE occurred. Elevated Lp(a) and hsCRP levels were associated with increased risks of MACCE (p<0.05). Notably, there might be a significant interaction between Lp(a) and hsCRP (P for interaction = 0.019). In the setting of hsCRP≥2 mg/L, significant higher risk of MACCE was observed with Lp(a) 15-29.9 mg/dL (HR: 1.18; 95% CI 1.01-1.39) and Lp(a) ≥30 mg/dL (HR: 1.20; 95% CI 1.04-1.39), whereas such association was attenuated when hsCRP was <2 mg/L with Lp(a) 15-29.9 mg/dL (HR: 0.94; 95% CI 0.80-1.10) and Lp(a) ≥30 mg/dL (HR: 1.12; 95% CI 0.98-1.28). Moreover, when Lp(a) and hsCRP were combined for risk stratification, patients with dual elevation of these two biomarkers had a significant higher risk of MACCE compared with the reference group (Lp(a) < 15 mg/dL and hsCRp<2 mg/L) (p<0.05).
Conclusions:
In patients with CAD undergoing PCI, high Lp(a) level was associated with worse outcomes, and this association might be stronger in those with elevated hsCRP concomitantly. Evaluation of Lp(a) and hsCRP together may help identify high-risk individuals for targeted intervention in clinical utility.
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