Association of Lp(a) Levels With Myocardial Infarction in Patients With Low-Attenuation Plaque
abstract
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Access this abstract now Full Text Available for ClinicalKey SubscribersBACKGROUND
Lipoprotein(a) (Lp[a]) is associated with an increased risk of myocardial infarction (MI). However, the mechanism underlying this association has yet to be fully elucidated.
OBJECTIVES
This multicenter study aimed to investigate whether association between Lp(a) and MI risk is reinforced by the presence of low-attenuation plaque (LAP) identified by coronary computed tomography angiography (CCTA).
METHODS
In a derivation cohort, a total of 5,607 patients with stable chest pain suspected of coronary artery disease who underwent CCTA and Lp(a) measurement were prospectively enrolled. In validation cohort, 1,122 patients were retrospectively collected during the same period. High Lp(a) was defined as Lp(a) ≥50 mg/dL. The primary endpoint was a composite of time to fatal or nonfatal MI. Associations were estimated using multivariable Cox proportional hazard models.
RESULTS
During a median follow-up of 8.2 years (Q1-Q3: 7.2-9.3 years), the elevated Lp(a) levels were associated with MI risk (adjusted HR [aHR]: 1.91; 95% CI: 1.46-2.49; P < 0.001). There was a significant interaction between Lp(a) and LAP (Pinteraction <0.001) in relation to MI risk. When stratified by the presence or absence of LAP, Lp(a) was associated with MI in patients with LAP (aHR: 3.03; 95% CI: 1.92-4.76; P < 0.001). Mediation analysis revealed that LAP mediated 73.3% (P < 0.001) for the relationship between Lp(a) and MI. The principal findings remained unchanged in the validation cohort.
CONCLUSIONS
Elevated Lp(a) augmented the risk of MI during 8 years of follow-up, especially in patients with LAP identified by CCTA. The presence of LAP could reinforce the relationship between Lp(a) and future MI occurrence.
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Additional Info
Association of Lipoprotein(a) Levels With Myocardial Infarction in Patients With Low-Attenuation Plaque
J Am Coll Cardiol 2024 May 07;83(18)1743-1755, MM Yu, ML Wang, JJ Wang, BL Lin, X Zhao, XW Tao, YY Chen, PY Li, JK Zhang, JB Ge, H Jin, MS ZengFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.