Elizabeth L Chou1, Mary Pettinger2, Bernhard Haring3, Matthew W Mell4, Mark A Hlatky5, Jean Wactawski-Wende6, Matthew A Allison7, Robert A Wild8, Aladdin H Shadyab7, Robert B Wallace9, Linda G Snetselaar9, Matthew J Eagleton10, Mark F Conrad10, Simin Liu11. 1. Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass. Electronic address: elchou@mgh.harvard.edu. 2. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Wash. 3. Department of Internal Medicine, University of Würzburg, Würzburg, Germany. 4. Division of Vascular Surgery, University of California, Davis, Medical Center, Sacramento, Calif. 5. Department of Health Research and Policy, Stanford University School of Medicine, Stanford, Calif. 6. Department of Epidemiology and Environmental Health, State University of New York at Buffalo, Buffalo, NY. 7. Department of Family Medicine and Public Health, University of California, San Diego, School of Medicine, La Jolla, Calif. 8. Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Okla. 9. Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa. 10. Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Mass. 11. Department of Epidemiology and Medicine, Brown University, Providence, RI.
Abstract
OBJECTIVE: Few studies have prospectively examined the associations of lipoprotein(a) [Lp(a)] levels with the risk of abdominal aortic aneurysm (AAA), especially in women. Accounting for commonly recognized risk factors, we investigated the baseline Lp(a) levels and the risk of AAA among postmenopausal women participating in the ongoing national Women's Health Initiative. METHODS: Women's Health Initiative participants with baseline Lp(a) levels available who were beneficiaries of Medicare parts A and B fee-for-service at study enrollment or who had aged into Medicare at any point were included. Participants with missing covariate data or known AAA at baseline were excluded. Thoracic aneurysms were excluded owing to the different pathophysiology. The AAA cases and interventions were identified using the International Classification of Diseases, 9th and 10th revision, codes and Current Procedural Terminology codes from claims data. Hazard ratios were computed using Cox proportional hazard models according to the quintiles of Lp(a). RESULTS: The mean age of the 6615 participants included in the analysis was 65.3 years. Of the 6615 participants, 66.6% were non-Hispanic white, 18.9% were black, 7% were Hispanic and 4.7% were Asian/Pacific Islander. Compared with the participants in the lowest Lp(a) quintile, those in higher quintiles were more likely to be overweight, black, and former or current smokers, to have hypertension, hyperlipidemia, and a history of cardiovascular disease, and to use menopausal hormone therapy and statins. During 65,476 person-years of follow-up, with a median of 10.4 years, 415 women had been diagnosed with an AAA and 36 had required intervention. More than one half had required intervention for a ruptured AAA. We failed to find a statistically significant association between Lp(a) levels and incident AAA. Additional sensitivity analyses stratified by race, with exclusion of statin users and alternative categorizations of Lp(a) using log-transformed levels, tertiles, and a cutoff of >50 mg/dL, were conducted, which did not reveal any significant associations. CONCLUSIONS: We found no statistically significant association between Lp(a) levels and the risk of AAA in a large and well-phenotyped sample of postmenopausal women. Women with high Lp(a) levels were more likely to be overweight, black, and former or current smokers, and to have hypertension, hyperlipidemia, and a history of cardiovascular disease, or to use hormone therapy and statins compared with those with lower Lp(a) levels. These findings differ from previous prospective, case-control, and meta-analysis studies that had supported a significant relationship between higher Lp(a) levels and an increased risk of AAA. Differences in the association could have resulted from study limitations or sex differences.
OBJECTIVE: Few studies have prospectively examined the associations of lipoprotein(a) [Lp(a)] levels with the risk of abdominal aortic aneurysm (AAA), especially in women. Accounting for commonly recognized risk factors, we investigated the baseline Lp(a) levels and the risk of AAA among postmenopausal women participating in the ongoing national Women's Health Initiative. METHODS: Women's Health Initiative participants with baseline Lp(a) levels available who were beneficiaries of Medicare parts A and B fee-for-service at study enrollment or who had aged into Medicare at any point were included. Participants with missing covariate data or known AAA at baseline were excluded. Thoracic aneurysms were excluded owing to the different pathophysiology. The AAA cases and interventions were identified using the International Classification of Diseases, 9th and 10th revision, codes and Current Procedural Terminology codes from claims data. Hazard ratios were computed using Cox proportional hazard models according to the quintiles of Lp(a). RESULTS: The mean age of the 6615 participants included in the analysis was 65.3 years. Of the 6615 participants, 66.6% were non-Hispanic white, 18.9% were black, 7% were Hispanic and 4.7% were Asian/Pacific Islander. Compared with the participants in the lowest Lp(a) quintile, those in higher quintiles were more likely to be overweight, black, and former or current smokers, to have hypertension, hyperlipidemia, and a history of cardiovascular disease, and to use menopausal hormone therapy and statins. During 65,476 person-years of follow-up, with a median of 10.4 years, 415 women had been diagnosed with an AAA and 36 had required intervention. More than one half had required intervention for a ruptured AAA. We failed to find a statistically significant association between Lp(a) levels and incident AAA. Additional sensitivity analyses stratified by race, with exclusion of statin users and alternative categorizations of Lp(a) using log-transformed levels, tertiles, and a cutoff of >50 mg/dL, were conducted, which did not reveal any significant associations. CONCLUSIONS: We found no statistically significant association between Lp(a) levels and the risk of AAA in a large and well-phenotyped sample of postmenopausal women. Women with high Lp(a) levels were more likely to be overweight, black, and former or current smokers, and to have hypertension, hyperlipidemia, and a history of cardiovascular disease, or to use hormone therapy and statins compared with those with lower Lp(a) levels. These findings differ from previous prospective, case-control, and meta-analysis studies that had supported a significant relationship between higher Lp(a) levels and an increased risk of AAA. Differences in the association could have resulted from study limitations or sex differences.
Authors: Weihua Guan; Jing Cao; Brian T Steffen; Wendy S Post; James H Stein; Mathew C Tattersall; Joel D Kaufman; Joseph P McConnell; Daniel M Hoefner; Russell Warnick; Michael Y Tsai Journal: Arterioscler Thromb Vasc Biol Date: 2015-02-19 Impact factor: 8.311
Authors: Eliano Pio Navarese; Michalina Kolodziejczak; Volker Schulze; Paul A Gurbel; Udaya Tantry; Yingfeng Lin; Maximilian Brockmeyer; David E Kandzari; Julia M Kubica; Ralph B D'Agostino; Jacek Kubica; Massimo Volpe; Stefan Agewall; Dean J Kereiakes; Malte Kelm Journal: Ann Intern Med Date: 2015-07-07 Impact factor: 25.391
Authors: H A Ashton; M J Buxton; N E Day; L G Kim; T M Marteau; R A P Scott; S G Thompson; N M Walker Journal: Lancet Date: 2002-11-16 Impact factor: 79.321
Authors: Douglas K Owens; Karina W Davidson; Alex H Krist; Michael J Barry; Michael Cabana; Aaron B Caughey; Chyke A Doubeni; John W Epling; Martha Kubik; C Seth Landefeld; Carol M Mangione; Lori Pbert; Michael Silverstein; Melissa A Simon; Chien-Wen Tseng; John B Wong Journal: JAMA Date: 2019-12-10 Impact factor: 56.272
Authors: Hind A Beydoun; Nazmus Saquib; Robert B Wallace; Jiu-Chiuan Chen; Mace Coday; Michelle J Naughton; May A Beydoun; Aladdin H Shadyab; Alan B Zonderman; Robert L Brunner Journal: Ann Clin Transl Neurol Date: 2022-06-24 Impact factor: 5.430