Coronary Artery Disease: Optimal Lipoprotein(a) for Survival-Lower Is Better? A Large Cohort With 43,647 Patients

Jin Liu; Liwei Liu; Bo Wang; Shiqun Chen; Buyun Liu; Jingjing Liang; Haozhang Huang; Qiang Li; Zhubin Lun; Ming Ying; Guanzhong Chen; Zhidong Huang; Danyuan Xu; Xiaoming Yan; Tingting Zhu; Girmaw Abebe Tadesse; Ning Tan; Jiyan Chen; Yong Liu

doi:10.3389/fcvm.2021.670859

Coronary Artery Disease: Optimal Lipoprotein(a) for Survival-Lower Is Better? A Large Cohort With 43,647 Patients

Front Cardiovasc Med. 2021 Aug 31:8:670859. doi: 10.3389/fcvm.2021.670859. eCollection 2021.

Authors

Jin Liu¹, Liwei Liu^{1

2}, Bo Wang¹, Shiqun Chen¹, Buyun Liu², Jingjing Liang³, Haozhang Huang³, Qiang Li¹, Zhubin Lun⁴, Ming Ying¹, Guanzhong Chen⁵, Zhidong Huang¹, Danyuan Xu¹, Xiaoming Yan⁶, Tingting Zhu⁷, Girmaw Abebe Tadesse⁷, Ning Tan^{1

3

5}, Jiyan Chen^{1

3

5}, Yong Liu^{1

3

5}

Affiliations

¹ Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
² Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States.
³ The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
⁴ Department of Cardiology, Dongguan TCM Hospital, Dongguan, China.
⁵ Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
⁶ Department of Information Technology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
⁷ Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom.

Abstract

Background: A high level of lipoprotein(a) can lead to a high risk of cardiovascular events or mortality. However, the association of moderately elevated lipoprotein(a) levels (≥15 mg/dL) with long-term prognosis among patients with coronary artery disease (CAD) is still uncertain. Hence, we aim to systematically analyzed the relevance of baseline plasma lipoprotein(a) levels to long-term mortality in a large cohort of CAD patients. Methods: We obtained data from 43,647 patients who were diagnosed with CAD and had follow-up information from January 2007 to December 2018. The patients were divided into two groups (<15 and ≥15 mg/dL). The primary endpoint was long-term all-cause death. Kaplan-Meier curve analysis and Cox proportional hazards models were used to investigate the association between moderately elevated baseline lipoprotein(a) levels (≥15 mg/dL) and long-term all-cause mortality. Results: During a median follow-up of 5.04 years, 3,941 (18.1%) patients died. We observed a linear association between lipoprotein(a) levels and long-term all-cause mortality. Compared with lipoprotein(a) concentrations <15 mg/dL, lipoprotein(a) ≥15 mg/dL was associated with a significantly higher risk of all-cause mortality [adjusted hazard ratio (aHR) 1.10, 95%CI: 1.04-1.16, P-values = 0.001). Similar results were found for the subgroup analysis of non-acute myocardial infarction, non-percutaneous coronary intervention, chronic heart failure, diabetes mellitus, or non-chronic kidney diseases. Conclusion: Moderately elevated baseline plasma lipoprotein(a) levels (≥15 mg/dL) are significantly associated with higher all-cause mortality in patients with CAD. Our finding provides a rationale for testing the lipoprotein(a)-reducing hypothesis with lower targets (even <15 mg/dL) in CAD outcome trials.

Keywords: baseline lipoprotein(a); coronary angiography; coronary artery disease; long-term all-cause mortality; percutaneous coronary intervention.