Inverse Association of Lipoprotein(a) on Long-Term Bleeding Risk in Patients with Coronary Heart Disease: Insight from a Multicenter Cohort in Asia

Peizhi Wang; Deshan Yuan; Xueyan Zhao; Pei Zhu; Xiaogang Guo; Lin Jiang; Na Xu; Zhifang Wang; Ru Liu; Qingsheng Wang; Yan Chen; Yongzhen Zhang; Jingjing Xu; Zhenyu Liu; Ying Song; Zheng Zhang; Yi Yao; Yingqing Feng; Xiaofang Tang; Xiaozeng Wang; Runlin Gao; Yaling Han; Jinqing Yuan

doi:10.1055/s-0043-1771188

Inverse Association of Lipoprotein(a) on Long-Term Bleeding Risk in Patients with Coronary Heart Disease: Insight from a Multicenter Cohort in Asia

Thromb Haemost. 2023 Jul 24. doi: 10.1055/s-0043-1771188. Online ahead of print.

Authors

Peizhi Wang¹, Deshan Yuan¹, Xueyan Zhao², Pei Zhu¹, Xiaogang Guo³, Lin Jiang¹, Na Xu¹, Zhifang Wang⁴, Ru Liu¹, Qingsheng Wang⁵, Yan Chen¹, Yongzhen Zhang⁶, Jingjing Xu¹, Zhenyu Liu⁷, Ying Song¹, Zheng Zhang⁸, Yi Yao¹, Yingqing Feng⁹, Xiaofang Tang¹, Xiaozeng Wang¹⁰, Runlin Gao¹, Yaling Han¹⁰, Jinqing Yuan^{1

11}

Affiliations

¹ Department of Cardiology, Center for Coronary Heart Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Special Demand Medical Care Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
³ Department of Cardiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
⁴ Department of Cardiology, Xinxiang Central Hospital, Xinxiang, Henan Province, China.
⁵ Department of Cardiology, The First Hospital of Qinhuangdao, Qinhuangdao, Hebei Province, China.
⁶ Department of Cardiology, Peking University Third Hospital, Beijing, China.
⁷ Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁸ Department of Cardiology, The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China.
⁹ Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangzhou, Guangdong Province, China.
¹⁰ Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, China.
¹¹ National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

PMID: 37487540
DOI: 10.1055/s-0043-1771188

Abstract

Background: Lipoprotein(a), or Lp(a), has been recognized as a strong risk factor for atherosclerotic cardiovascular disease. However, the relationship between Lp(a) and bleeding remains indistinct, especially in the secondary prevention population of coronary artery disease (CAD). This investigation aimed to evaluate the association of Lp(a) with long-term bleeding among patients with CAD.

Methods: Based on a prospective multicenter cohort of patients with CAD consecutively enrolled from January 2015 to May 2019 in China, the current analysis included 16,150 participants. Thus, according to Lp(a) quintiles, all subjects were divided into five groups. The primary endpoint was bleeding at 2-year follow-up, and the secondary endpoint was major bleeding at 2-year follow-up.

Results: A total of 2,747 (17.0%) bleeding and 525 (3.3%) major bleeding were recorded during a median follow-up of 2.0 years. Kaplan-Meier survival analysis showed the highest bleeding incidence in Lp(a) quintile 1, compared with patients in Lp(a) quintiles 2 to 5 (p < 0.001), while the incidence of major bleeding seemed similar between the two groups. Moreover, restricted cubic spline analysis suggested that there was an L-shaped association between Lp(a) and 2-year bleeding after adjustment for potential confounding factors, whereas there was no significant association between Lp(a) and 2-year major bleeding.

Conclusion: There was an inverse and L-shaped association of Lp(a) with bleeding at 2-year follow-up in patients with CAD. More attention and effort should be made to increase the clinician awareness of Lp(a)'s role, as a novel marker for bleeding risk to better guide shared-decision making in clinical practice.

The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).