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Published on: October 12, 2017
Lipoprotein(a) as a novel biomarker for predicting adverse outcomes in ischemic heart failure
Biyang Zhang1, Yinxiao Xu1, Xin Huang1
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
High Lipoprotein(a) [Lp(a)] levels significantly increase the risk of major adverse cardiovascular events (MACE) in patients with ischemic heart failure (IHF). This association is stronger in individuals with a higher body mass index (BMI).
Area of Science:
- Cardiology
- Biochemistry
- Clinical Research
Background:
- Lipoprotein(a) [Lp(a)] is a recognized risk factor for atherosclerotic cardiovascular disease (ASCVD).
- The specific impact of Lp(a) on adverse outcomes in ischemic heart failure (IHF) patients requires further elucidation.
- Understanding this relationship is crucial for risk stratification and management of IHF.
Purpose of the Study:
- To investigate the association between serum Lp(a) levels and the incidence of major adverse cardiovascular events (MACE) in IHF patients.
- To explore the nonlinear relationship between Lp(a) and MACE risk.
- To identify potential interactions with patient characteristics like body mass index (BMI).
Main Methods:
- A single-center retrospective cohort study included 1,168 IHF patients undergoing percutaneous coronary intervention (PCI).
- Patients were stratified into four groups based on Lp(a) quartiles.
- Cox proportional hazards models and restricted cubic spline (RCS) curves were used to analyze the association between Lp(a) levels and MACE (all-cause mortality, non-fatal myocardial infarction, any revascularization).
Main Results:
- MACE incidence significantly increased across Lp(a) quartiles (Quartile 4 vs. Quartile 1: 46.4% vs. 22.9%, P < 0.001).
- Elevated Lp(a) was independently associated with increased risk of MACE (HR, 2.28; 95% CI, 1.69-3.07), mortality (HR, 2.33; 95% CI, 1.54-3.54), and revascularization (HR, 2.18; 95% CI, 1.35-3.53).
- A nonlinear positive relationship between Lp(a) and MACE risk was observed, with a stronger association in patients with higher BMI (P for interaction < 0.001).
Conclusions:
- Elevated Lp(a) levels are an independent predictor of MACE, mortality, and revascularization in IHF patients.
- The risk associated with Lp(a) is nonlinear and more pronounced in patients with higher BMI.
- These findings highlight Lp(a) as a critical biomarker for risk assessment in IHF.
Background:
Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD). However, the association between Lp(a) and adverse outcomes in patients with ischemic heart failure (IHF) remains unclear. This study aimed to investigate the relationship between serum Lp(a) levels and the incidence of major adverse cardiovascular events (MACE) in IHF patients.
Methods:
In this single-center, retrospective cohort study, 1,168 IHF patients who underwent elective percutaneous coronary intervention (PCI) were enrolled. Patients were divided into four groups based on Lp(a) quartiles. The primary endpoint was MACE, defined as a composite of all-cause mortality, non-fatal myocardial infarction (MI), and any revascularization. Cox proportional hazards models were used to evaluate the association between Lp(a) quartiles and adverse outcomes. Restricted cubic spline (RCS) curve were constructed to explore the nonlinear relationship between Lp(a) levels and MACE risk. Subgroup analyses were performed to investigate the association in different subgroups.
Results:
The incidence of MACE increased significantly across Lp(a) quartiles (Quartile 4 vs. Quartile 1: 46.4% vs. 22.9%, P < 0.001). After adjusting for confounding factors, the highest Lp(a) group remained independently associated with an increased risk of MACE (HR, 95% CI: 2.28, 1.69-3.07, P < 0.001, P for trend <0.001), all-cause mortality (HR, 95% CI: 2.33, 1.54-3.54, P < 0.001, P for trend = 0.01), and any revascularization (HR, 95% CI: 2.18, 1.35-3.53, P = 0.002, P for trend = 0.001). The RCS model demonstrated a nonlinear positive relationship between Lp(a) levels and MACE risk. Subgroup analysis revealed a significant interaction with body mass index (BMI), with a more pronounced association observed in patients with higher BMI (P for interaction <0.001).
Conclusion:
Elevated Lp(a) levels were independently associated with an increased risk of MACE, mortality, and revascularization in IHF patients, with a stronger effect in obese individuals.
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