Paul J Nestel1, Elizabeth H Barnes, Andrew M Tonkin, John Simes, Marion Fournier, Harvey D White, David M Colquhoun, Stefan Blankenberg, David R Sullivan. 1. From the Lipoprotein and Atherosclerosis Laboratory, Baker IDI Heart & Diabetes Institute, Melbourne, Australia (P.J.N.); NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia (E.H.B., J.S., M.F.); Department of Epidemiology & Preventative Medicine, Monash University, Melbourne, Australia (A.M.T.); Green Lane Cardiovascular Research Unit, Auckland City Hospital, Auckland, New Zealand (H.D.W.); Department of Medicine, University of Queensland, Brisbane, Australia (D.M.C.); Department of General and Interventional Cardiology, University Heart Centre Hamburg, Hamburg, Germany (S.B.); and Royal Prince Alfred Hospital Department of Biochemistry, Sydney, Australia (D.R.S.).
Abstract
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.
RCT Entities:
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.
Authors: Nishant P Shah; Neha J Pajidipati; Robert W McGarrah; Ann Marie Navar; Sreekanth Vemulapalli; Michael A Blazing; Svati H Shah; Adrian F Hernandez; Manesh R Patel Journal: Am J Cardiol Date: 2020-04-07 Impact factor: 2.778
Authors: Rutger Verbeek; S Matthijs Boekholdt; Robert M Stoekenbroek; G Kees Hovingh; Joseph L Witztum; Nicholas J Wareham; Manjinder S Sandhu; Kay-Tee Khaw; Sotirios Tsimikas Journal: J Lipid Res Date: 2016-01-31 Impact factor: 5.922