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Lipoprotein(a) levels and risk of abdominal aortic aneurysm in the Women's Health Initiative
- Source :
- J Vasc Surg, Journal of vascular surgery, vol 73, iss 4
- Publication Year :
- 2020
-
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.
- Subjects :
- Aging
Time Factors
Comorbidity
030204 cardiovascular system & hematology
Overweight
Cardiovascular
Medical and Health Sciences
0302 clinical medicine
Risk Factors
Hyperlipidemia
030212 general & internal medicine
Prospective Studies
biology
Women's Health Initiative
Incidence
Hazard ratio
Lipoprotein(a)
Middle Aged
Prognosis
Aortic Aneurysm
Postmenopause
Current Procedural Terminology
Pacific islanders
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
medicine.medical_specialty
Statin
medicine.drug_class
Women's health
Aortic Rupture
Medicare
Risk Assessment
Article
03 medical and health sciences
Sex Factors
Clinical Research
Internal medicine
medicine
Humans
Abdominal
Aged
Dyslipidemias
business.industry
Prevention
medicine.disease
United States
Good Health and Well Being
Cardiovascular System & Hematology
biology.protein
Abdominal aortic aneurysm
Women's Health
Surgery
business
Biomarkers
Aortic Aneurysm, Abdominal
Subjects
Details
- ISSN :
- 10976809
- Volume :
- 73
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Journal of vascular surgery
- Accession number :
- edsair.doi.dedup.....5cf30ebe23d5ffd08e24bc57021bb9d4