High lipoprotein(a) increased the risk of ASCVD independent of C-reactive protein levels (HR 1.61 for CRP <2 mg/L and HR 1.57 for CRP ≥2 mg/L; P for interaction=0.87).
Cohort (n=68,090)
Does high lipoprotein(a) increase the risk of ASCVD, myocardial infarction, and aortic valve stenosis independent of C-reactive protein levels in the general population?
High lipoprotein(a) is a main driver for the risk of ASCVD, myocardial infarction, and aortic valve stenosis independent of C-reactive protein levels.
Effect estimate: HR 1.61 (CRP <2 mg/l) and HR 1.57 (CRP ≥2 mg/l) (95% CI 1.43-1.81 and 1.36-1.82)
p-value: p=0.87 for interaction
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.
Thomas et al. (Tue,) conducted a cohort in Atherosclerotic cardiovascular disease (ASCVD) (n=68,090). High lipoprotein(a) vs. Low lipoprotein(a) ≤6 mg/dl (1st-33rd percentiles) was evaluated on Atherosclerotic cardiovascular disease (ASCVD) (HR 1.61 (CRP <2 mg/l) and HR 1.57 (CRP ≥2 mg/l), 95% CI 1.43-1.81 and 1.36-1.82, p=0.87 for interaction). High lipoprotein(a) increased the risk of ASCVD independent of C-reactive protein levels (HR 1.61 for CRP <2 mg/L and HR 1.57 for CRP ≥2 mg/L; P for interaction=0.87).