Relation of First and Total Recurrent Atherosclerotic Cardiovascular Disease Events to Increased Lipoprotein(a) Levels Among Statin Treated Adults With Cardiovascular Disease.

Pubmed ID: 33454339

Pubmed Central ID: PMC8005472

Journal: The American journal of cardiology

Publication Date: April 15, 2021

Affiliation: Global Outcomes Research, Novartis Inc.

MeSH Terms: Humans, Male, Female, Aged, Cardiovascular Diseases, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Middle Aged, Coronary Disease, Proportional Hazards Models, Hospitalization, Prognosis, Myocardial Infarction, Myocardial Revascularization, Atherosclerosis, Cholesterol, LDL, Lipoprotein(a), Acute Coronary Syndrome, Ischemic Stroke

Grants: U01 HL081616, U01 HL081649

Authors: Zhao Y, Wong ND, Sung J, Browne A

Cite As: Wong ND, Zhao Y, Sung J, Browne A. Relation of First and Total Recurrent Atherosclerotic Cardiovascular Disease Events to Increased Lipoprotein(a) Levels Among Statin Treated Adults With Cardiovascular Disease. Am J Cardiol 2021 Apr 15;145:12-17. Epub 2021 Jan 14.

Studies:

Abstract

The relation between elevated lipoprotein(a) and total atherosclerotic cardiovascular disease (ASCVD) residual risk in persons with known cardiovascular disease on statin therapy is not well-established. We examined first and total recurrent ASCVD event risk in statin-treated adults with prior ASCVD. We studied 3,359 adults (mean age 63.6 years, 85.1% male) with prior ASCVD on statin therapy from the AIM-HIGH clinical trial cohort. The first and total ASCVD event rates were calculated by lipoprotein(a) [Lp(a)] categories. Cox regression and Prentice, Williams and Peterson (PWP) models provided hazard ratios (HRs) for ASCVD events over a mean follow-up of 3.3 years, adjusted for age, gender, trial treatment, LDL-C, and other risk factors. A total of 747 events occurred during follow-up, among which 544 were first events. First and total ASCVD event rates were greater with higher Lp(a) levels. Compared with Lp(a)<15 mg/dL, HRs (95% CIs) for subsequent total ASCVD events among Lp(a) levels of 15-<30, 30-<50, 50-<70, and ≥70 mg/dL were 1.04 (0.82 to 1.32), 1.15 (0.88 to 1.49), 1.27 (1.00 to 1.63) and 1.51 (1.25 to 1.84). Moreover, a continuous relation for total events was observed (HR=1.08 [1.04 to 1.12] per 20 mg/dL greater Lp(a). Findings for first ASCVD events and in those with LDL-C ≥70 mg/dL versus <70 mg/dL and with and without diabetes were similar. The risk of first and total ASCVD events is increased with Lp(a) levels of ≥70 mg/dL and ≥50 mg/dL, respectively, among adults with known CVD on statin therapy.