Association of lipoprotein(a) with progression of coronary artery calcification: retrospective longitudinal study
Anna Lee1, Hyun-Min Koh1, Ji-Yong Jang1
1Department of Family Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
Insights
Elevated lipoprotein(a) (Lp(a)) levels are linked to coronary artery calcification (CAC) progression in a general population. Further research is needed to confirm Lp(a) as a cardiovascular disease predictor.
Area of Science:
- Cardiology
- Biomarkers
- Public Health
Background:
- Atherosclerotic cardiovascular disease (ASCVD) poses a significant health risk.
- Lipoprotein(a) (Lp(a)) is an established independent risk factor for ASCVD.
- Limited data exists on Lp(a) and ASCVD risk in Asian populations, necessitating further investigation.
Purpose of the Study:
- To evaluate the predictive capability of coronary artery calcification (CAC) changes for ASCVD risk in relation to lipoprotein(a) (Lp(a)) levels.
- To assess the association between Lp(a) levels and CAC progression in a general population.
- To explore the utility of Lp(a) as a biomarker for subclinical atherosclerosis.
Main Methods:
- A cohort of 2,750 participants was analyzed, stratified by Lp(a) levels.
- Coronary artery calcification (CAC) progression was defined by incident CAC or significant change in CAC scores (Δ√transformed CACS).
- Statistical analyses adjusted for follow-up duration and other potential confounders.
Main Results:
- A significant correlation was observed between higher Lp(a) levels and increased baseline/follow-up CAC scores and CAC progression.
- Participants with CAC progression exhibited notably higher Lp(a) levels.
- Annualized CAC progression analysis did not yield statistically significant results, suggesting a need for longer follow-up.
Conclusions:
- Elevated Lp(a) levels are associated with CAC progression in a general population without established ASCVD.
- Longer-term studies are required to establish the predictive value of CAC progression for ASCVD events.
- Further research is essential to define clinically relevant Lp(a) thresholds for cardiovascular risk assessment in specific populations, such as the Korean population.
Background:
Atherosclerotic cardiovascular disease (ASCVD) is a major health concern, and lipoprotein(a) (Lp(a)) is an independent risk factor. However, there is limited evidence regarding Lp(a) and the risk of ASCVD in Asian populations. This study aimed to assess the predictive value of changes in coronary artery calcification (CAC) for ASCVD risk associated with Lp(a) level.
Methods:
Participants (n=2,750) were grouped according to their Lp(a) levels, and the association between Lp(a) and CAC progression was examined. CAC progression was defined as the occurrence of incident CAC or a difference ≥2.5 between the square root (√) of baseline and follow-up coronary artery calcium scores (CACSs) (Δ√transformed CACS). To adjust for differences in follow-up periods, Δ√transformed CACS was divided by the follow- up period (in years).
Results:
Over an average follow-up of 3.07 years, 18.98% of participants experienced CAC progression. Those with disease progression had notably higher Lp(a) levels. Higher Lp(a) tertiles correlated with increased baseline and follow-up CACS, CAC progression (%), and Δ√transformed CACS. Even after adjustment, higher Lp(a) levels were associated with CAC progression. However, annualized Δ√transformed CACS analysis yielded no significant results.
Conclusion:
This study demonstrated an association between elevated Lp(a) levels and CAC progression in a general population without ASCVD. However, longer-term follow-up studies are needed to obtain meaningful results regarding CAC progression. Further research is necessary to utilize Lp(a) level as a predictor of cardiovascular disease and to establish clinically relevant thresholds specific to the Korean population.
