Background: Lipoprotein(a) Lp(a) and oxidized phospholipids (OxPLs) are each independent risk factors for atherosclerotic cardiovascular disease (ASCVD). The extent to which Lp(a) and OxPLs predict coronary artery disease (CAD) severity and outcomes in a contemporary, statin-treated cohort is not well established. Objectives: To evaluate the relationships between Lp(a) particle concentration and OxPLs associated with apolipoprotein B (OxPL-apoB) or apolipoprotein(a) OxPL-apo(a) with angiographic CAD and cardiovascular outcomes. Methods: Among 1098 participants referred for coronary angiography in the CASABLANCA study (Catheter Sampled Blood Archive in Cardiovascular Diseases, ClinicalTrials.gov NCT00842868), Lp(a), OxPL-apoB and OxPL-apo(a) were measured. Logistic regression estimated risk of multi-vessel coronary stenoses by Lp(a)-related biomarker level. Cox proportional hazards regression estimated risk of major adverse cardiovascular events (MACE; coronary revascularization, non-fatal MI, non-fatal stroke, and cardiovascular death) in follow-up. Results: Median IQR Lp(a) was 26.45 nmol/L 11.39-89.49. Lp(a), OxPL-apoB, and OxPL-apo(a) were highly correlated (Spearman R≥0.91 for all pairwise combinations). Lp(a) and OxPL-apoB were associated with multi-vessel CAD. Odds of multi-vessel CAD per doubling of Lp(a), OxPL-apoB, and OxPL-apo(a) were 1.10 (95% CI 1.03-1.18, P=0.006), 1.18 (95% CI 1.03-1.34, P=0.01), and 1.07 (95% CI 0.99-1.16, P=0.07), respectively. All biomarkers were associated with cardiovascular (CV) events. Hazard ratios for MACE per doubling of Lp(a), OxPL-apoB, and OxPL-apo(a) were 1.08 (95% CI 1.03-1.14, P=0.001), 1.15 (95% CI 1.05-1.26, P=0.004), and 1.07 (95% CI 1.01-1.14, P=0.02), respectively. Conclusions: In patients undergoing coronary angiography, Lp(a) and OxPL-apoB are associated with multi-vessel CAD. Lp(a), OxPL-apoB, and OxPL-apo(a) are associated with incident CV events.
Gilliland et al. (Mon,) studied this question.