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Lipoprotein(a), Cardiovascular Events and Sex Differences: A Single Cardiological Unit Experience
Beatrice Dal Pino1, Francesca Gorini2, Melania Gaggini2
1Fondazione Gabriele Monasterio CNR-Regione Toscana, 56124 Pisa, Italy.
Insights
Elevated Lipoprotein(a) (Lp(a)) predicts adverse cardiovascular events in women with type 2 diabetes, but not in men or those without diabetes. This finding highlights sex-specific risk in cardiovascular disease prognosis.
Area of Science:
- Cardiology
- Endocrinology
- Genetics
Background:
- Lipoprotein(a) (Lp(a)) possesses proatherogenic and prothrombotic characteristics.
- Hormonal and metabolic influences can alter Lp(a) levels.
- Limited research explores sex-based differences and cardiometabolic risk factors impacting Lp(a)'s role in cardiovascular disease prognosis.
Purpose of the Study:
- To assess the predictive capability of Lp(a) for hard cardiovascular events (HEs).
- To investigate these predictions based on sex and the presence of cardiometabolic risk factors.
- To analyze Lp(a) as a prognostic marker in patients undergoing coronary angiography.
Main Methods:
- Kaplan-Meier analysis was used for subgroup comparisons.
- Cox multivariate regression models were employed for adjusted analyses.
- Patients (n=2110) were stratified by sex, type 2 diabetes (T2D) status, and Lp(a) levels (>30 mg/dL).
Main Results:
- Elevated Lp(a) (>30 mg/dL) did not worsen prognosis in the overall patient cohort.
- A significantly worse prognosis was observed in females with T2D and elevated Lp(a) (p=0.03).
- After multivariate adjustment, Lp(a) independently predicted HEs in T2D females (HR 2.9, p<0.05).
Conclusions:
- Lipoprotein(a) is a potent independent predictor of hard events specifically in women with type 2 diabetes.
- Lp(a) does not appear to be an independent prognostic factor for hard events in T2D men or patients without T2D.
- These findings underscore the importance of considering sex and diabetes status when evaluating Lp(a) for cardiovascular risk stratification.
Abstract:
Lipoprotein(a)-Lp(a), which retains proatherogenic and prothrombotic properties, may be modified by hormonal and metabolic factors. However, few studies have focused on differences related to sex and cardiometabolic risk factors in the relationship between Lp(a) and cardiovascular disease, especially in terms of prognosis. This study aimed at evaluating the predictive value of Lp(a) (cut-off 30 mg/dL) for hard events (HEs: mortality and non-fatal myocardial infarction) according to sex and cardiometabolic risk factors in 2110 patients (1501 males, mean age: 68 ± 9 years) undergoing coronary angiography for known or suspected coronary artery disease. There were 211 events over a median follow-up period of 33 months. Lp(a) > 30 mg/dL did not confer a worse prognosis on the overall population. However, Kaplan-Meier subgroup analysis evidenced a worse prognosis in type 2 diabetes (T2D) females with elevated Lp(a) (log-rank test: p = 0.03) vs. T2D males and no-T2D patients, but not in other high-risk cardiovascular states (e.g., smoking, hypertension, reduced left ventricular ejection fraction or obesity). After Cox multivariate adjustment, Lp(a) remained an independent determinant for HEs in the T2D female subgroup, conferring an HR of 2.9 (95% CI 1.1-7.7, p < 0.05). Lp(a) is therefore a strong independent predictor of HR in T2D women, but not in T2D men, or in noT2D patients.
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