Low lipoprotein(a) concentration is associated with higher atrial fibrillation risk: A large retrospective cohort study

BACKGROUND AND AIMS: The role of serum lipoprotein(a) [Lp(a)] levels in atrial fibrillation (AF) is still uncertain, especially in the Chinese population. Here we aimed to elucidate the potential relationship between Lp(a) quantiles and AF risk. METHODS: From 2017 to 2021, 4,511 patients with AF and 9,022 patients without AF were 1:2 matched by the propensity score matching method. Interactions between AF risk, Lp(a) quantiles, and other clinical indices were analyzed by logistics regression and stratified analysis. RESULTS: 46.9% of the study group were women, and the baseline mean age exhibited 65 years. The AF group exhibited lower median Lp(a) than the non-AF group (15.95 vs. 16.90 mg/dL; P< 0.001). The AF risk decreased from 34.2% (Q1) to 30.9% (Q4) ( P< 0.001). Lp(a) quantiles 1-3 increased the AF risk 1.162 fold (1.049-1.286), 1.198 fold (1.083-1.327), and 1.111 fold (1.003-1.231) in the unadjusted logistics model, respectively. Lp(a) levels in female patients exhibited significantly negatively correlated with AF (OR of Q1: 1.394[1.194-1.626], P= 0.001). Age and hypertension did not affect the adverse correlation. CONCLUSION: For female patients whose serum Lp(a) concentration was less than 16.54 mg/dL, there was a higher risk of suffering from AF. Thus, we recommend a pre-emptive screening for AF in women with low Lp(a) plasma levels.