Plasma lipoprotein(a) concentration predicts future coronary and cardiovascular events in patients with stable coronary heart disease

TY - JOUR

T1 - Plasma lipoprotein(a) concentration predicts future coronary and cardiovascular events in patients with stable coronary heart disease

AU - Nestel, Paul J

AU - Barnes, Elizabeth H

AU - Tonkin, Andrew M

AU - Simes, John

AU - Fournier, Marion

AU - White, Harvey D

AU - Colquhoun, David M

AU - Blankenberg, Stefan

AU - Sullivan, David R

PY - 2013/12

Y1 - 2013/12

N2 - OBJECTIVE: Association between lipoprotein(a) (Lp(a)) level and a first-ever coronary (CHD) event is recognized. Less is evident in patients with overt CHD and stable symptoms in whom we investigated associations between Lp(a) and future events.APPROACH AND RESULTS: Relationships between Lp(a) concentration and CHD and cardiovascular disease outcomes during 6 years' median follow-up were evaluated in the Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) study. Lp(a) concentrations were measured in plasma from 7863 patients who had sustained a previous coronary event and been randomized to pravastatin or placebo. Lp(a) levels were categorized by lowest half, third quartile, 75th to 90th percentile, and highest decile. The prognostic value of Lp(a) on outcomes was assessed by fitting a Cox proportional-hazards model after adjustment for other risk factors and baseline cardiovascular disorders. The prognostic value of a change in Lp(a) at year 1 categorized by quartiles was assessed using Cox regression in a landmark model incorporating the above factors and baseline levels. Baseline Lp(a) concentration was associated with total CHD events (P<0.001), total cardiovascular disease events (P=0.002), and coronary events (P=0.03). Greatest risk occurred at >73 mg/dL, upper decile. For events after year 1, an increase in Lp(a) at 1 year was associated with adverse outcomes for total CHD events and total cardiovascular disease events (P=0.002 each).CONCLUSIONS: In the LIPID study, baseline Lp(a) was associated with future cardiovascular disease and CHD events. Increased Lp(a) concentrations after 1 year were also associated with future events, supporting measurement of Lp(a) for risk assessment of patients with known CHD.

AB - OBJECTIVE: Association between lipoprotein(a) (Lp(a)) level and a first-ever coronary (CHD) event is recognized. Less is evident in patients with overt CHD and stable symptoms in whom we investigated associations between Lp(a) and future events.APPROACH AND RESULTS: Relationships between Lp(a) concentration and CHD and cardiovascular disease outcomes during 6 years' median follow-up were evaluated in the Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) study. Lp(a) concentrations were measured in plasma from 7863 patients who had sustained a previous coronary event and been randomized to pravastatin or placebo. Lp(a) levels were categorized by lowest half, third quartile, 75th to 90th percentile, and highest decile. The prognostic value of Lp(a) on outcomes was assessed by fitting a Cox proportional-hazards model after adjustment for other risk factors and baseline cardiovascular disorders. The prognostic value of a change in Lp(a) at year 1 categorized by quartiles was assessed using Cox regression in a landmark model incorporating the above factors and baseline levels. Baseline Lp(a) concentration was associated with total CHD events (P<0.001), total cardiovascular disease events (P=0.002), and coronary events (P=0.03). Greatest risk occurred at >73 mg/dL, upper decile. For events after year 1, an increase in Lp(a) at 1 year was associated with adverse outcomes for total CHD events and total cardiovascular disease events (P=0.002 each).CONCLUSIONS: In the LIPID study, baseline Lp(a) was associated with future cardiovascular disease and CHD events. Increased Lp(a) concentrations after 1 year were also associated with future events, supporting measurement of Lp(a) for risk assessment of patients with known CHD.

KW - Aged

KW - Angina, Unstable/blood

KW - Australia/epidemiology

KW - Biomarkers/blood

KW - Coronary Disease/blood

KW - Disease Progression

KW - Disease-Free Survival

KW - Female

KW - Follow-Up Studies

KW - Humans

KW - Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use

KW - Lipoprotein(a)/blood

KW - Male

KW - Middle Aged

KW - Myocardial Infarction/blood

KW - New Zealand/epidemiology

KW - Pravastatin/therapeutic use

KW - Predictive Value of Tests

KW - Proportional Hazards Models

KW - Risk Assessment

KW - Risk Factors

KW - Time Factors

KW - Up-Regulation

U2 - 10.1161/ATVBAHA.113.302479

DO - 10.1161/ATVBAHA.113.302479

M3 - SCORING: Journal article

C2 - 24092750

VL - 33

SP - 2902

EP - 2908

JO - ARTERIOSCL THROM VAS

JF - ARTERIOSCL THROM VAS

SN - 1079-5642

IS - 12

ER -