Lipoprotein(a) and Risk of Incident Atherosclerotic Cardiovascular Disease: Impact of High-Sensitivity C-Reactive Protein and Risk Variability Among Human Clinical Subgroups

Figures

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  Figure 1. Adjusted 10-year inclusive ASCVD event risk across clinical strata of Lp(a). (A) All participants, males, and females. (B) Non-Black and Black participants. (C) Non-diabetic and diabetic participants. Model 1: Adjusted for age, sex, and race. Model 2: Adjusted for age, sex, race, diabetes status, hypertension, hypertension treatment, smoking status, total cholesterol, high-density lipoprotein cholesterol, and cholesterol-lowering medication use. Lp(a) values were classified according to prespecified clinical strata. The HR (95% CI) is shown in comparison to the Lp(a) < 10 mg/dL stratum (reference). p value represents trend across the categories; the C statistic represents the probably of an event across the categories. Abbreviations: ASCVD, atherosclerotic cardiovascular disease; CI, confidence interval; HR, hazard ratio; Lp(a), lipoprotein(a).

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  Figure 2. Adjusted 10-year CHD risk across clinical strata of Lp(a). (A) All participants, males, and females. (B) Non-Black and Black participants. (C) Non-diabetic and diabetic participants. Model 1: Adjusted for age, sex, and race. Model 2: Adjusted for age, sex, race, diabetes status, hypertension, hypertension treatment, smoking status, total cholesterol, high-density lipoprotein cholesterol, and cholesterol-lowering medication use. Lp(a) values were classified according to prespecified clinical strata. The HR (95% CI) is shown in comparison to the Lp(a) < 10 mg/dL stratum (reference). p value represents trend across the categories; the C statistic represents the probably of an event across the categories. Abbreviations: CHD, coronary heart disease; CI, confidence interval; HR, hazard ratio; Lp(a), lipoprotein(a).

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  Figure 3. The 10-year ASCVD event risk of all participants across clinical strata of Lp(a) dichotomized by pooled cohort equation risk score. (A) Unadjusted event risk. (B) Adjusted event risk, adjusted for age, sex, race, systolic blood pressure, hypertension treatment, total cholesterol, smoking status, and high-density lipoprotein cholesterol. Lp(a) values were classified according to prespecified clinical strata. HR (95% CI), HRadj, and p value are shown in comparison to the Lp(a) < 30 mg/dL stratum (reference). Abbreviations: ASCVD, atherosclerotic cardiovascular disease; CI, confidence interval; HR, hazard ratio; HRadj, adjusted hazard ratio; Lp(a), lipoprotein(a).

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  Figure 4. Adjusted 10-year ASCVD event risk in participants classified by Lp(a) and hs-CRP levels. (A) All participants. (B) Non-Black participants. (C) Black participants. Table shows number of events, HRadj, and p value by Lp(a) and hs-CRP clinical strata. Cox proportional hazards model was adjusted for age, sex, race (Panel A only), systolic blood pressure, hypertension treatment, smoking status, diabetes status, total cholesterol, high-density lipoprotein cholesterol, and cholesterol-lowering medication use. Lp(a) < 50 mg/dL and hs-CRP < 2 mg/L was used as the reference group. Graph presents Kaplan–Meier curves of cumulative incidence of events by prespecified Lp(a) and hs-CRP clinical strata. Black line indicates Lp(a) < 50 mg/dL and hs-CRP < 2 mg/L; red line shows Lp(a) ≥ 50 mg/dL and hs-CRP < 2 mg/L; green line shows Lp(a) < 50 mg/dL and hs-CRP ≥ 2 mg/L; blue line shows ≥50 mg/dL and hs-CRP ≥ 2 mg/dL. Abbreviations: ASCVD, atherosclerotic cardiovascular disease; CHD, coronary heart disease; CI, confidence interval; HR, hazard ratio; HRadj, adjusted hazard ratio; hs-CRP, high sensitivity C-reactive protein; Lp(a), lipoprotein(a).

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  Figure 5. Adjusted 10-year CHD event risk in participants classified by Lp(a) and hs-CRP levels. (A) All participants. (B) Non-Black participants. (C) Black participants. Table shows number of events, HRadj (95% CI), and p value by Lp(a) and hs-CRP clinical strata. Cox proportional hazards model was adjusted for age, sex, race (Panel A only), systolic blood pressure, hypertension treatment, smoking status, diabetes status, total cholesterol, high-density lipoprotein cholesterol, and cholesterol-lowering medication use. Lp(a) < 50 mg/dL and hs-CRP < 2 mg/L was used as the reference group. Graph presents Kaplan–Meier curves of cumulative incidence of events by prespecified Lp(a) and hs-CRP clinical strata. Black line indicates Lp(a) < 50 mg/dL and hs-CRP < 2 mg/L; red line shows Lp(a) ≥ 50 mg/dL and hs-CRP < 2 mg/L; green line shows Lp(a) < 50 mg/dL and hs-CRP ≥ 2 mg/L; blue line shows ≥50 mg/dL and hs-CRP ≥ 2 mg/dL. Abbreviations: CHD, coronary heart disease; CI, confidence interval; HRadj, adjusted hazard ratio; hs-CRP, high-sensitivity C-reactive protein; Lp(a), lipoprotein(a).