Elevated lipoprotein(a) increases risk of subsequent major adverse cardiovascular events (MACE) and coronary revascularisation in incident ASCVD patients: a cohort study from the UK biobank

Welsh, P. et al. (2024) Elevated lipoprotein(a) increases risk of subsequent major adverse cardiovascular events (MACE) and coronary revascularisation in incident ASCVD patients: a cohort study from the UK biobank. Atherosclerosis, 389, 117437. (doi: 10.1016/j.atherosclerosis.2023.117437) (PMID:38219651)

Abstract

Background and aims: Elevated lipoprotein(a) [Lp(a)] is a genetic driver for atherosclerotic cardiovascular disease (ASCVD). We aimed to provide novel insights on the associated risk of elevated versus normal Lp(a) levels on major adverse cardiovascular events (MACE) in an incident ASCVD cohort. Methods: This was an observational cohort study of incident ASCVD patients. MACE counts and incidence rates (IRs) per 100-person-years were reported for patients with normal (<65 nmol/L) and elevated (>150 nmol/L) Lp(a) within the first year after incident ASCVD diagnosis and overall follow-up. Cox proportional hazard models quantified the risk of MACE associated with a 100 nmol/L increase in Lp(a). Results: The study cohort included 32,537 incident ASCVD patients; 5204 with elevated and 22,257 with normal Lp(a). Of those with elevated Lp(a), 41.2% had a subsequent MACE, versus 35.61% with normal Lp(a). Within the first year of follow-up, the IRs of composite MACE and coronary revascularisation were significantly higher (p < 0.001) in patients with elevated versus normal Lp(a) (IR difference 6.79 and 4.66). This trend was also observed in the overall follow-up (median 4.7 years). Using time to first subsequent MACE, a 100 nmol/L increase in Lp(a) was associated with an 8.0% increased risk of composite MACE, and 18.6% increased risk of coronary revascularisation during the overall follow-up period. Conclusions: The association of elevated Lp(a) with increased risk of subsequent MACE and coronary revascularisation, highlights a population who may benefit from earlier and more targeted intervention for cardiovascular risk including Lp(a), particularly within the first year after ASCVD diagnosis. Proactive Lp(a) testing as part of routine clinical practice can help to identify and better manage these higher-risk individuals.

• Item Type: Articles
• Additional Information: This study was funded by Novartis Pharma AG, Basel, Switzerland. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
• Keywords: Lipoprotein(a), ASCVD, MACE, coronary revascularisation, non-fatal myocardial infarction.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Brown, Miss Rosemary and Welsh, Professor Paul and Sattar, Professor Naveed

Creator Roles

Welsh, P.: Conceptualization, Methodology, Investigation, Writing – review and editing
Brown, R.: Investigation, Writing – review and editing
Sattar, N.: Conceptualization, Investigation, Writing – review and editing

• Authors: Welsh, P., Al Zabiby, A., Byrne, H., Benbow, H. R., Itani, T., Farries, G., Costa-Scharplatz, M., Ferber, P., Martin, L., Brown, R., Fonseca, A. F., and Sattar, N.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Atherosclerosis
• Publisher: Elsevier
• ISSN: 0021-9150
• ISSN (Online): 1879-1484
• Published Online: 27 December 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in Atherosclerosis 389:117437
• Publisher Policy: Reproduced under a Creative Commons License