Lipoprotein(a) for risk assessment in patients with established coronary artery disease.

Abstract

OBJECTIVES:

The purpose of this study was to assess the prognostic utility of lipoprotein(a) [Lp(a)] in individuals with coronary artery disease (CAD).

BACKGROUND:

Data regarding an association between Lp(a) and cardiovascular (CV) risk in secondary prevention populations are sparse.

METHODS:

Plasma Lp(a) was measured in 6,708 subjects with CAD from 3 studies; data were then combined with 8 previously published studies for a total of 18,978 subjects.

RESULTS:

Across the 3 studies, increasing levels of Lp(a) were not associated with the risk of CV events when modeled as a continuous variable (odds ratio [OR]: 1.03 per log-transformed SD, 95% confidence interval [CI]: 0.96 to 1.11) or by quintile (Q5:Q1 OR: 1.05, 95% CI: 0.83 to 1.34). When data were combined with previously published studies of Lp(a) in secondary prevention, subjects with Lp(a) levels in the highest quantile were at increased risk of CV events (OR: 1.40, 95% CI: 1.15 to 1.71), but with significant between-study heterogeneity (p = 0.001). When stratified on the basis of low-density lipoprotein (LDL) cholesterol, the association between Lp(a) and CV events was significant in studies in which average LDL cholesterol was ≥130 mg/dl (OR: 1.46, 95% CI: 1.23 to 1.73, p < 0.001), whereas this relationship did not achieve statistical significance for studies with an average LDL cholesterol <130 mg/dl (OR: 1.20, 95% CI: 0.90 to 1.60, p = 0.21).

CONCLUSIONS:

Lp(a) is significantly associated with the risk of CV events in patients with established CAD; however, there exists marked heterogeneity across trials. In particular, the prognostic value of Lp(a) in patients with low cholesterol levels remains unclear.

• Authors: Michelle L O'Donoghue, David A Morrow, Sotirios Tsimikas, Sarah Sloan, Angela F Ren, Elaine B Hoffman, Nihar R Desai, Scott D Solomon, Michael Domanski, Kiyohito Arai, Stephanie E Chiuve, Christopher P Cannon, Frank M Sacks, Marc S Sabatine
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 63 Issue 6 Pg. 520-7 (Feb 18 2014) ISSN: 1558-3597 [Electronic] United States
• PMID: 24161323 (Publication Type: Journal Article, Meta-Analysis, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Lipoprotein(a)

Topics

• Acute Coronary Syndrome (blood, diagnosis, therapy)
• Biomarkers (blood)
• Coronary Artery Disease (blood, diagnosis, drug therapy)
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (therapeutic use)
• Lipoprotein(a) (blood)
• Prognosis
• Randomized Controlled Trials as Topic
• Risk Assessment
• Secondary Prevention