Residual atherosclerotic risk in older patients with ASCVD: where hsCRP meets Lp(a)

Background The relative importance of high-sensitivity CRP (hsCRP) and lipoprotein(a) [Lp(a)] as determinants for cardiovascular risk are unknown among elderly patients (≥75 years) with established atherosclerotic cardiovascular disease (ASCVD), a population poorly represented in prior studies. Method The present study prospectively enrolled 2,333 patients aged ≥75 years diagnosed with ASCVD at Fuwai Hospital. The primary endpoint was major adverse cardiovascular event (MACE), defined as a composite of all-cause death, myocardial infarction, stroke, or ischemia-driven coronary revascularization. Results Over a median follow-up time of 3.0 years, hsCRP demonstrated a significant dose-dependent association with MACE risk (adjusted HR [aHR]: 1.05, 95% CI: 1.03-1.08 per 1 mg/L increment; highest versus lowest quartile: aHR: 1.70, 95% CI: 1.22-2.38), whereas Lp(a) showed no independent association (aHR: 1.02, 95% CI: 0.98-1.06 per 10 mg/dL increment; highest versus lowest quartile: aHR: 1.06, 95% CI: 0.77-1.47). Risks of MACE were significantly higher in participants with hsCRP ≥2 mg/L than in those with hsCRP <2 mg/L, irrespective of Lp(a) strata (aHR: 1.41, 95% CI: 1.12-1.79). The highest risk occurred when both hsCRP ≥2 mg/L and Lp(a) ≥30 mg/dL were present (aHR: 1.54, 95% CI: 1.13-2.12). Conclusions These findings indicate that systemic inflammation measured by hsCRP is a stronger predictor of recurrent cardiovascular events than Lp(a) in elderly ASCVD patients, suggesting potential clinical utility of anti-inflammatory interventions for secondary prevention in this population.Centrai illustration