1. Lipoprotein(a) is linked to atherothrombosis and aortic valve stenosis independent of C-reactive protein.
- Author
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Thomas PE, Vedel-Krogh S, Kamstrup PR, and Nordestgaard BG
- Subjects
- Male, Humans, Female, C-Reactive Protein, Lipoprotein(a), Prospective Studies, Risk Factors, Aortic Valve, Aortic Valve Stenosis epidemiology, Myocardial Infarction epidemiology, Myocardial Infarction etiology, Atherosclerosis epidemiology
- Abstract
Aims: Recent evidence suggest that the lipoprotein(a)-associated risk of atherosclerotic cardiovascular disease (ASCVD) may be observed only in individuals with low-grade systemic inflammation. It was hypothesized that high lipoprotein(a) is a main driver for the risk of ASCVD, myocardial infarction, and aortic valve stenosis irrespective of C-reactive protein levels., Methods and Results: A total of 68 090 individuals from the Copenhagen General Population Study, a prospective cohort study, were included. During a median follow-up of 8.1 years, 5104 individuals developed ASCVD, 2432 myocardial infarction, and 1220 aortic valve stenosis. The risk of ASCVD, myocardial infarction, and aortic valve stenosis increased with higher values of both lipoprotein(a) and C-reactive protein. For individuals with lipoprotein(a) in the 91st-100th percentiles (≥70 mg/dl, ≥147 nmol/l) vs. the 1st-33rd percentiles (≤6 mg/dl, ≤9 nmol/l), the multivariable-adjusted hazard ratio for ASCVD was 1.61 (95% confidence interval 1.43-1.81) for those with C-reactive protein <2 mg/l and 1.57 (1.36-1.82) for those with C-reactive protein ≥2 mg/l (P for interaction = 0.87). The corresponding values were 2.08 (1.76-2.45) and 1.65 (1.34-2.04) for myocardial infarction, and 2.01 (1.59-2.55) and 1.73 (1.31-2.27) for aortic valve stenosis, respectively (P for interaction = 0.15 and = 0.18). The highest absolute 10-year risks were found in men aged 70-79 years with lipoprotein(a) levels in the 91st-100th percentiles and C-reactive protein ≥2 mg/l, with 34% for ASCVD, 19% for myocardial infarction, and 13% for aortic valve stenosis. The corresponding values in women were 20%, 10%, and 8%, respectively., Conclusion: High lipoprotein(a) was a main driver for the risk of ASCVD, myocardial infarction, and aortic valve stenosis independent of C-reactive protein levels., Competing Interests: Conflicts of interest: B.G.N. reports consultancies with Akcea, Amarin, Amgen, AstraZeneca, Denka, Kowa, Novartis, Novo Nordisk, Sanofi, Regeneron, Esperion, and Silence Therapeutics. P.R.K. reports lecture honoraria or consultancies from Physicians’ Academy for Cardiovascular Education, Silence Therapeutics, and Novartis. P.E.T. and S.V.-K. declare no conflicts of interest., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2023
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