Eric J Brandt1, Arya Mani2, Erica S Spatz3, Nihar R Desai3, Khurram Nasir4. 1. National Clinician Scholars Program, Yale School of Medicine, New Haven, CT, USA; Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA. Electronic address: EricJBrandtMD@gmail.com. 2. Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA; Department of Genetics, Yale School of Medicine, New Haven, CT, USA. 3. Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, USA; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA. 4. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA.
Abstract
BACKGROUND: Lipoprotein(a) (Lp(a)) has not been well-studied in a nationally representative US cohort. OBJECTIVE: The objective of this study was to investigate the distribution of Lp(a) and its associations with nonfatal cardiovascular events in a nationally representative cohort. METHODS: Cross-sectional analysis using the National Health and Nutrition Examination Survey III cohort (1991-1994). We compared Lp(a) levels across demographics and tested the associations between Lp(a) and patient-reported nonfatal myocardial infarction (MI) and/or stroke using multivariate logistic regression. RESULTS: Median Lp(a) was 14 mg/dL (interquartile range [IQR]: 3, 32) (n = 8214). 14.7% (95% CI: 13.6%-15.9%) had Lp(a) ≥50 mg/dL. Women had slightly higher median Lp(a) than men (14 mg/dL [IQR: 4, 33] vs 13 [(IQR: 3, 30], P = .001). Non-Hispanics blacks had the highest median Lp(a) (35 mg/dL [IQR: 21, 64]), followed by non-Hispanic whites (12 mg/dL [IQR: 3, 29]) and Mexican Americans (8 mg/dL [IQR:1, 21]). In multivariate analysis, Lp(a) was associated (odds ratio per SD increase [95% CI], P-value) with MI (1.41 [1.14-1.75], P = .001), but not stroke (1.14 [0.91-1.44], P = .26). Lp(a) associated with MI in men (1.52 [1.13-2.04], P = .006), non-Hispanic whites (1.60 [1.27-2.03], P < .001), and Mexican Americans (2.14 [1.29-3.55], P = .003), but not women or non-Hispanic blacks. Lp(a) was not associated with stroke among any subgroups. CONCLUSION: In a nationally representative US cohort, 1 in 7 had Lp(a) ≥50 mg/dL, the guidelines-recommended threshold to consider Lp(a) a risk enhancing factor. Lp(a) was associated with nonfatal MI but not stroke, although there were differential associations by sex and race/ethnicity. Future nationally representative cohorts should test Lp(a) to get an updated estimation.
BACKGROUND:Lipoprotein(a) (Lp(a)) has not been well-studied in a nationally representative US cohort. OBJECTIVE: The objective of this study was to investigate the distribution of Lp(a) and its associations with nonfatal cardiovascular events in a nationally representative cohort. METHODS: Cross-sectional analysis using the National Health and Nutrition Examination Survey III cohort (1991-1994). We compared Lp(a) levels across demographics and tested the associations between Lp(a) and patient-reported nonfatal myocardial infarction (MI) and/or stroke using multivariate logistic regression. RESULTS: Median Lp(a) was 14 mg/dL (interquartile range [IQR]: 3, 32) (n = 8214). 14.7% (95% CI: 13.6%-15.9%) had Lp(a) ≥50 mg/dL. Women had slightly higher median Lp(a) than men (14 mg/dL [IQR: 4, 33] vs 13 [(IQR: 3, 30], P = .001). Non-Hispanics blacks had the highest median Lp(a) (35 mg/dL [IQR: 21, 64]), followed by non-Hispanic whites (12 mg/dL [IQR: 3, 29]) and Mexican Americans (8 mg/dL [IQR:1, 21]). In multivariate analysis, Lp(a) was associated (odds ratio per SD increase [95% CI], P-value) with MI (1.41 [1.14-1.75], P = .001), but not stroke (1.14 [0.91-1.44], P = .26). Lp(a) associated with MI in men (1.52 [1.13-2.04], P = .006), non-Hispanic whites (1.60 [1.27-2.03], P < .001), and Mexican Americans (2.14 [1.29-3.55], P = .003), but not women or non-Hispanic blacks. Lp(a) was not associated with stroke among any subgroups. CONCLUSION: In a nationally representative US cohort, 1 in 7 had Lp(a) ≥50 mg/dL, the guidelines-recommended threshold to consider Lp(a) a risk enhancing factor. Lp(a) was associated with nonfatal MI but not stroke, although there were differential associations by sex and race/ethnicity. Future nationally representative cohorts should test Lp(a) to get an updated estimation.
Authors: Sebhat Erqou; Stephen Kaptoge; Philip L Perry; Emanuele Di Angelantonio; Alexander Thompson; Ian R White; Santica M Marcovina; Rory Collins; Simon G Thompson; John Danesh Journal: JAMA Date: 2009-07-22 Impact factor: 56.272
Authors: S M Haffner; K K Gruber; P A Morales; H P Hazuda; R A Valdez; B D Mitchell; M P Stern Journal: Am J Epidemiol Date: 1992-11-01 Impact factor: 4.897
Authors: Andrew Moran; Albert Shen; Daniel Turner-Lloveras; Aayla Khan; Els Clays; Walter Palmas; Dirk De Bacquer Journal: Heart Date: 2012-09-02 Impact factor: 5.994
Authors: Guillaume Paré; Artuela Çaku; Matthew McQueen; Sonia S Anand; Enas Enas; Robert Clarke; Michael B Boffa; Marlys Koschinsky; Xingyu Wang; Salim Yusuf Journal: Circulation Date: 2019-03-19 Impact factor: 29.690
Authors: Børge G Nordestgaard; M John Chapman; Kausik Ray; Jan Borén; Felicita Andreotti; Gerald F Watts; Henry Ginsberg; Pierre Amarenco; Alberico Catapano; Olivier S Descamps; Edward Fisher; Petri T Kovanen; Jan Albert Kuivenhoven; Philippe Lesnik; Luis Masana; Zeljko Reiner; Marja-Riitta Taskinen; Lale Tokgözoglu; Anne Tybjærg-Hansen Journal: Eur Heart J Date: 2010-10-21 Impact factor: 29.983
Authors: Eric J Brandt; Daniel J Brandt; Nihar R Desai; Erica S Spatz; Khurram Nasir; Arya Mani Journal: Int J Vitam Nutr Res Date: 2021-05-24 Impact factor: 1.784