Lipoprotein(a) and Major Adverse Cardiovascular Events in Patients With or Without Baseline Atherosclerotic Cardiovascular Disease

被引：44

作者：

Berman, Adam N. ^{[1
]}

Biery, David W. ^{[1
]}

Besser, Stephanie A. ^{[1
]}

Singh, Avinainder ^{[1
]}

Shiyovich, Arthur ^{[1
]}

Weber, Brittany N. ^{[1
]}

Huck, Daniel M. ^{[1
]}

Divakaran, Sanjay ^{[1
]}

Hainer, Jon ^{[2
]}

Kaur, Gurleen ^{[3
]}

Blaha, Michael J. ^{[4
]}

Cannon, Christopher P. ^{[1
]}

Plutzky, Jorge ^{[1
]}

Januzzi, James L. ^{[5
]}

Booth, John N. ^{[6
]}

Lopez, J. Antonio G. ^{[7
]}

Kent, Shia T. ^{[6
]}

Nasir, Khurram ^{[8
]}

Carli, Marcelo F. Di ^{[1
,2
]}

Bhatt, Deepak L. ^{[9
]}

Blankstein, Ron ^{[1
,2
,10
]}

机构：

[1] Harvard Med Sch, Brigham & Womens Hosp, Dept Med, Div Cardiovasc Med, Boston, MA 02115 USA

[2] Harvard Med Sch, Brigham & Womens Hosp, Dept Radiol, Boston, MA USA

[3] Harvard Med Sch, Brigham & Womens Hosp, Dept Med, Boston, MA USA

[4] Johns Hopkins Ciccarone Ctr Prevent Heart Dis, Baltimore, MD USA

[5] Harvard Med Sch, Massachusetts Gen Hosp, Baim Inst Clin Res, Cardiol Div, Boston, MA USA

[6] Amgen Inc, Ctr Observat Res, Thousand Oaks, CA USA

[7] Amgen Inc, Global Dev, Thousand Oaks, CA USA

[8] Houston Methodist DeBakey Heart & Vasc Ctr, Div Cardiovasc Prevent & Wellness, Dept Cardiovasc Med, Houston, TX USA

[9] Mt Sinai Fuster Heart Hosp, Icahn Sch Med Mt Sinai Hlth Syst Mt Sinai Heart, New York, NY USA

[10] Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2024年 / 83卷 / 09期

基金：

美国国家卫生研究院;

关键词：

lipoprotein(a) cohort; lipoprotein(a) therapies; CORONARY-HEART-DISEASE; ELEVATED LIPOPROTEIN(A); MYOCARDIAL-INFARCTION; RISK-ASSESSMENT; DIAGNOSIS; ACCURACY; STROKE; THRESHOLDS; ALIROCUMAB; PREVENTION;

D O I：

10.1016/j.jacc.2023.12.031

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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. (J Am Coll Cardiol 2024;83:873-886) (c) 2024 by the American College of Cardiology Foundation.

引用

页码：873 / 886

页数：14

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