Yanglu Zhao1,2, Joseph A Delaney3, Ruben G W Quek4, Julius M Gardin5, Calvin H Hirsch6, Shravanthi R Gandra4, Nathan D Wong1. 1. Heart Disease Prevention Program, Division of Cardiology, University of California Irvine, Irvine, California. 2. Department of Epidemiology, School of Public Health, University of California, Los Angeles, California. 3. Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington. 4. Global Health Economics, Amgen Inc., Thousand Oaks, California. 5. Department of Medicine, Hackensack University Medical Center, Hackensack, New Jersey. 6. Department of Medicine, University of California Davis, Davis, California.
Abstract
BACKGROUND: The value of lipoprotein(a) (Lp[a]) for predicting cardiovascular disease (CVD) across low-density lipoprotein cholesterol (LDL-C) is uncertain. HYPOTHESIS: In older high-risk adults, higher LDL and Lp(a) combined would be associated with higher CVD risk and more healthcare costs. METHODS: We included 3251 high-risk subjects (prior CVD, diabetes, or 10-year Framingham CVD risk >20%) age ≥65 years from the Cardiovascular Health Study and examined the relation of Lp(a) tertiles with incident CVD, coronary heart disease (CHD), and all-cause mortality within LDL-C strata (spanning <70 mg/dL to ≥160 mg/dL). We also examined 1-year all-cause and CVD healthcare costs from Medicare claims. RESULTS: Over a 22.5-year follow-up, higher Lp(a) levels predicted CVD and total mortality (both standardized hazard ratio [HR]: 1.06, P < 0.01), whereas higher LDL-C levels predicted higher CHD (standardized HR: 1.09, P < 0.01) but lower total mortality (standardized HR: 0.94, P < 0.001). Adjusted HRs in the highest (vs lowest) tertile of Lp(a) level were 1.95 (P = 0.06) for CVD events and 2.68 (P = 0.03) for CHD events when LDL-C was <70 mg/dL. One-year all-cause healthcare costs were increased for Lp(a) ($771 per SD of 56 µg/mL [P = 0.03], $1976 for Lp(a) 25-64 µg/mL vs <25 µg/mL [P = 0.02], and $1648 for Lp(a) ≥65 µg/mL vs <25 µg/mL [P = 0.054]) but not LDL-C. CONCLUSIONS: In older high-risk adults, increased Lp(a) levels were associated with higher CVD risk, especially in those with LDL-C <70 mg/dL, and with higher healthcare costs.
BACKGROUND: The value of lipoprotein(a) (Lp[a]) for predicting cardiovascular disease (CVD) across low-density lipoprotein cholesterol (LDL-C) is uncertain. HYPOTHESIS: In older high-risk adults, higher LDL and Lp(a) combined would be associated with higher CVD risk and more healthcare costs. METHODS: We included 3251 high-risk subjects (prior CVD, diabetes, or 10-year Framingham CVD risk >20%) age ≥65 years from the Cardiovascular Health Study and examined the relation of Lp(a) tertiles with incident CVD, coronary heart disease (CHD), and all-cause mortality within LDL-C strata (spanning <70 mg/dL to ≥160 mg/dL). We also examined 1-year all-cause and CVD healthcare costs from Medicare claims. RESULTS: Over a 22.5-year follow-up, higher Lp(a) levels predicted CVD and total mortality (both standardized hazard ratio [HR]: 1.06, P < 0.01), whereas higher LDL-C levels predicted higher CHD (standardized HR: 1.09, P < 0.01) but lower total mortality (standardized HR: 0.94, P < 0.001). Adjusted HRs in the highest (vs lowest) tertile of Lp(a) level were 1.95 (P = 0.06) for CVD events and 2.68 (P = 0.03) for CHD events when LDL-C was <70 mg/dL. One-year all-cause healthcare costs were increased for Lp(a) ($771 per SD of 56 µg/mL [P = 0.03], $1976 for Lp(a) 25-64 µg/mL vs <25 µg/mL [P = 0.02], and $1648 for Lp(a) ≥65 µg/mL vs <25 µg/mL [P = 0.054]) but not LDL-C. CONCLUSIONS: In older high-risk adults, increased Lp(a) levels were associated with higher CVD risk, especially in those with LDL-C <70 mg/dL, and with higher healthcare costs.
Authors: Kazuhiko Kotani; Amirhossein Sahebkar; Corina Serban; Florina Andrica; Peter P Toth; Steven R Jones; Karam Kostner; Michael J Blaha; Seth Martin; Jacek Rysz; Stephen Glasser; Kausik K Ray; Gerald F Watts; Dimitri P Mikhailidis; Maciej Banach Journal: Atherosclerosis Date: 2015-07-02 Impact factor: 5.162
Authors: Ralph B D'Agostino; Ramachandran S Vasan; Michael J Pencina; Philip A Wolf; Mark Cobain; Joseph M Massaro; William B Kannel Journal: Circulation Date: 2008-01-22 Impact factor: 29.690
Authors: Michelle L O'Donoghue; David A Morrow; Sotirios Tsimikas; Sarah Sloan; Angela F Ren; Elaine B Hoffman; Nihar R Desai; Scott D Solomon; Michael Domanski; Kiyohito Arai; Stephanie E Chiuve; Christopher P Cannon; Frank M Sacks; Marc S Sabatine Journal: J Am Coll Cardiol Date: 2013-10-23 Impact factor: 24.094
Authors: Emanuele Di Angelantonio; Pei Gao; Lisa Pennells; Stephen Kaptoge; Muriel Caslake; Alexander Thompson; Adam S Butterworth; Nadeem Sarwar; David Wormser; Danish Saleheen; Christie M Ballantyne; Bruce M Psaty; Johan Sundström; Paul M Ridker; Dorothea Nagel; Richard F Gillum; Ian Ford; Pierre Ducimetiere; Stefan Kiechl; Wolfgang Koenig; Robin P F Dullaart; Gerd Assmann; Ralph B D'Agostino; Gilles R Dagenais; Jackie A Cooper; Daan Kromhout; Altan Onat; Robert W Tipping; Agustín Gómez-de-la-Cámara; Annika Rosengren; Susan E Sutherland; John Gallacher; F Gerry R Fowkes; Edoardo Casiglia; Albert Hofman; Veikko Salomaa; Elizabeth Barrett-Connor; Robert Clarke; Eric Brunner; J Wouter Jukema; Leon A Simons; Manjinder Sandhu; Nicholas J Wareham; Kay-Tee Khaw; Jussi Kauhanen; Jukka T Salonen; William J Howard; Børge G Nordestgaard; Angela M Wood; Simon G Thompson; S Matthijs Boekholdt; Naveed Sattar; Chris Packard; Vilmundur Gudnason; John Danesh Journal: JAMA Date: 2012-06-20 Impact factor: 56.272