Key result
Elevated Lp(a) is linked to ~20% higher odds of interstitial myocardial fibrosis per log-unit.
Why the study?
Are elevated lipoprotein(a) levels associated with increased interstitial and replacement myocardial fibrosis and adverse cardiac remodeling on cardiac magnetic resonance in a multi-ethnic community cohort free of baseline clinical cardiovascular disease?
Cohort (n=2,826)
Yes
Are elevated lipoprotein(a) levels associated with increased interstitial and replacement myocardial fibrosis and adverse cardiac remodeling on cardiac magnetic resonance in a multi-ethnic community cohort free of baseline clinical cardiovascular disease?
Answers are grounded in this paper and cite their sources.
In the multi-ethnic MESA cohort, elevated Lp(a) levels independently correlated with subclinical diffuse interstitial fibrosis, replacement myocardial scar, and left atrial remodeling on CMR, even after accounting for coronary calcification, myocardial infarction, and aortic stenosis.
BACKGROUND Lipoprotein(a) (Lp[a]) has been identified as an emerging risk factor for adverse cardiovascular (CV) outcomes, including heart failure. However, the connections among Lp(a), myocardial fibrosis (interstitial and replacement), and cardiac remodeling as pathways to CV diseases remains unclear. OBJECTIVES This study investigated the relationship between Lp(a) levels and myocardial fibrosis by cardiac magnetic resonance (CMR) T1 mapping and late gadolinium enhancement, as well as cardiac remodeling by cine CMR, in the MESA (Multi-Ethnic Study of Atherosclerosis) cohort. METHODS The study included 2,040 participants with baseline Lp(a) measurements and T1 mapping for interstitial myocardial fibrosis (IMF) evaluation in 2010. Lp(a) was analyzed as a continuous variable (per log unit) and using clinical cutoff values of 30 and 50 mg/dL. Multivariate linear and logistic regression were used to assess the associations of Lp(a) with CMR measures of extracellular volume (ECV fraction [ECV%]), native T1 time, and myocardial scar, as well as parameters of cardiac remodeling, in 2,826 participants. RESULTS Higher Lp(a) levels were associated with increased ECV% (per log-unit Lp[a]; β = 0.2%; P = 0.007) and native T1 time (per log-unit Lp[a]; β = 4%; P < 0.001). Similar relationships were observed between elevated Lp(a) levels and a higher risk of clinically significant IMF defined by prognostic thresholds per log-unit Lp(a) of ECV% (OR: 1.20; 95% CI: 1.04–1.43) and native T1 (OR: 1.2; 95% CI: 1.1–1.4) equal to 30% and 955 ms, respectively. Clinically used Lp(a) cutoffs (30 and 50 mg/dL) were associated with greater prevalence of myocardial scar (OR: 1.85; 95% CI: 1.1–3.2 and OR: 1.9; 95% CI: 1.1–3.4, respectively). Finally, higher Lp(a) levels were associated with left atrial enlargement and dysfunction. CONCLUSIONS Elevated Lp(a) levels are linked to greater subclinical IMF, increased myocardial scar prevalence, and left atrial remodeling.
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Chehab et al. (2023) conducted a cohort in Subclinical myocardial fibrosis and cardiac remodeling (n=2,826). Elevated baseline lipoprotein(a) [Lp(a)] levels (analyzed per log-unit increase and at clinical cutoffs of >=30 and >=50 mg/dL) vs. Lower baseline Lp(a) levels (<30 mg/dL or lowest quartile) was evaluated on Clinically significant interstitial myocardial fibrosis defined by extracellular volume fraction (ECV%) >=30% per log-unit Lp(a) (OR 1.20, 95% CI 1.04-1.43, p=0.007). Elevated lipoprotein(a) levels were associated with greater interstitial fibrosis (ECV% >=30%: OR 1.20 per log-unit, 95% CI 1.04-1.43) and myocardial scar (>=30 mg/dL: OR 1.85, 95% CI 1.1-3.2).
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