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Lipoprotein(a) and Major Adverse Cardiovascular Events in Patients With or Without Baseline Atherosclerotic
Adam N Berman1, David W Biery2, Stephanie A Besser2
1Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. Electronic address: https://twitter.com/adambermanMD.
Insights
Elevated Lipoprotein(a) [Lp(a)] increases cardiovascular risk. This study suggests different Lp(a) thresholds for risk assessment in patients with and without established atherosclerotic cardiovascular disease (ASCVD).
Area of Science:
- Cardiology
- Genetics
- Public Health
Background:
- Lipoprotein(a) [Lp(a)] is a known risk factor for atherosclerotic cardiovascular disease (ASCVD).
- Optimal Lp(a) thresholds for cardiovascular risk assessment may vary based on an individual's baseline ASCVD status.
- Understanding these differences is crucial for effective primary and secondary prevention strategies.
Purpose of the Study:
- To investigate the association between Lp(a) levels and major adverse cardiovascular events (MACE).
- To determine if the Lp(a) threshold for risk stratification differs between patients with and without established ASCVD.
Main Methods:
- Retrospective cohort study of 16,419 patients with Lp(a) measurements from 2000-2019.
- Lp(a) levels were categorized into percentile groups.
- Cox proportional hazards modeling was used to assess the association between Lp(a) and incident MACE (MI, stroke, revascularization, cardiovascular mortality).
Main Results:
- Elevated Lp(a) was independently associated with increased MACE risk in both ASCVD and non-ASCVD groups.
- In patients with established ASCVD, Lp(a) levels in the 71st-90th and 91st-100th percentiles showed increased MACE hazard.
- In patients without established ASCVD, higher Lp(a) percentiles demonstrated a continuously increasing hazard of MACE, with the highest risk in the 91st-100th percentile group.
Conclusions:
- Elevated Lp(a) is a significant independent predictor of long-term MACE in both patients with and without baseline ASCVD.
- The findings suggest that distinct Lp(a) risk assessment thresholds may be warranted for primary versus secondary prevention cohorts.
- This highlights the need for personalized risk stratification based on Lp(a) levels and ASCVD history.
Background:
Lipoprotein(a) [Lp(a)] is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). However, whether the optimal Lp(a) threshold for risk assessment should differ based on baseline ASCVD status is unknown.
Objectives:
The purpose of this study was to assess the association between Lp(a) and major adverse cardiovascular events (MACE) among patients with and without baseline ASCVD.
Methods:
We studied a retrospective cohort of patients with Lp(a) measured at 2 medical centers in Boston, Massachusetts, from 2000 to 2019. To assess the association of Lp(a) with incident MACE (nonfatal myocardial infarction [MI], nonfatal stroke, coronary revascularization, or cardiovascular mortality), Lp(a) percentile groups were generated with the reference group set at the first to 50th Lp(a) percentiles. Cox proportional hazards modeling was used to assess the association of Lp(a) percentile group with MACE.
Results:
Overall, 16,419 individuals were analyzed with a median follow-up of 11.9 years. Among the 10,181 (62%) patients with baseline ASCVD, individuals in the 71st to 90th percentile group had a 21% increased hazard of MACE (adjusted HR: 1.21; P < 0.001), which was similar to that of individuals in the 91st to 100th group (adjusted HR: 1.26; P < 0.001). Among the 6,238 individuals without established ASCVD, there was a continuously higher hazard of MACE with increasing Lp(a), and individuals in the 91st to 100th Lp(a) percentile group had the highest relative risk with an adjusted HR of 1.93 (P < 0.001).
Conclusions:
In a large, contemporary U.S. cohort, elevated Lp(a) is independently associated with long-term MACE among individuals with and without baseline ASCVD. Our results suggest that the threshold for risk assessment may be different in primary vs secondary prevention cohorts.
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