Elevated lipoprotein(a) and risk of coronary heart disease according to different lipid profiles in the general Chinese community population: the CHCN-BTH study

Abstract

Background: To evaluate the contributions of elevated lipoprotein(a) [Lp(a)] to the risk of coronary heart disease (CHD) in the general Chinese community population according to different lipid profiles. Methods: We recruited individuals aged over 18 years from the baseline survey of the Cohort Study on Chronic Disease of Communities Natural Population in Beijing, Tianjin and Hebei (CHCN-BTH) using a stratified, multistage cluster sampling method. Data were collected through questionnaire surveys, anthropometric measures and laboratory tests. Restricted cubic spline (RCS) functions, multivariate logistic regression, sensitivity analyses and stratified analyses were used to evaluate the association between Lp(a) and CHD.Results: A total of 25,343 participants were included, with 1,364 (5.38%) identified as having CHD.Elevated Lp(a) levels were linearly related to an increased risk of CHD (P overall-association <0.0001 and P nonlinear-association =0.8468). Multivariate logistic regression analysis indicated that subjects with Lp(a) ≥300 mg/L had a higher risk of CHD [OR (95% CI): 1.36 (1.17, 1.57)] than did individuals with Lp(a) <300 mg/L. Compared with individuals with Lp(a) <119.0 mg/L (<50th percentile), the ORs (95% CI) for CHD in the 51st-80th, 81st-95th and >95th percentiles were 1.07 (0.93, 1.23), 1.26 (1.07, 1.50) and 1.68 (1.30, 2.17), respectively (P for trend <0.0001). This association was also found among the subgroup of subjects without dyslipidemia, including those with normal total cholesterol (TC) (<6.2 mmol/L), triglycerides (TG) (<2.3 mmol/L), highdensity lipoprotein cholesterol (HDL-C) (≥1.0 mmol/L) and low-density lipoprotein cholesterol (LDL-C) (<4.1 mmol/L). Elevated Lp(a) and dyslipidemia significantly contributed to a higher risk of CHD with synergistic effects. Stratified analyses showed that elevated Lp(a) concentrations were significantly associated with an increased risk of CHD in the subgroups of individuals who were noncurrent drinkers, overweight individuals, individuals with hypertension, individuals who engaged in moderate physical activity, those

Elevated lipoprotein(a) as a predictor for coronary events in older men

“…Whilst absolute cutoffs may be beneficial for decision making within the clinic, a linear increase in atherosclerotic CVD risk has been observed with Lp(a) concentration, suggesting that even a modest increase in Lp(a) may be determinantal ( 23 ). Notably, within this study, the observation that no difference was found between low (<30 mg/dl) and elevated (30–50 mg/dl) Lp(a) in ACS risk differs from recent findings, where Lp(a) levels over 30 mg/dl contributed to an increased risk of coronary heart disease ( 44 ) and a linear relationship with both fatal and nonfatal cardiovascular risk ( 45 , 46 ). This may, in part, be due to the disparity in race between the two studies.…”

Elevated lipoprotein(a) levels as an independent predictor of long-term recurrent events in patients with acute coronary syndrome: an observational, retrospective cohort study

“…To the best of our knowledge, a large number of studies have demonstrated that Lp(a) plays an important role in the risk of CVD as primary prevention in the general people with different races, such as White, Black, Asian and mixed [3][4][5][20][21][22]. As for secondary prevention, the association between Lp(a) levels and the risk of subsequent CVEs has been recognized in the patients with established coronary artery diseases (CAD), even they were complicated with diabetes [6,7,19,23].…”

“…Recently, lipoprotein(a) [Lp(a)] has been recognized as a novel independent risk factor for the incidence of CHD [3][4][5][6][7], which is consisted of a low-density lipoprotein-like particle and apolipoprotein B100, with apolipoprotein(a) [apo(a)], the characteristic protein of Lp(a), covalently binding to it via a disulfide binding [8]. Compositionally, Lp(a) shows higher pathogenicity compared with LDLcholesterol (LDL-C) in CHD due to the presence of apo(a), which is regarded as the major causative factor of atherosclerosis, thrombosis and inflammation [9].…”

The Prevalence of Diabetes, Prediabetes and Associated Risk Factors in Hangzhou, Zhejiang Province: A Community-Based Cross-Sectional Study

“…Dyslipidemia: total cholesterol (TC) ≥6.2 mmol/L and/or triglyceride (TG) ≥2.3 mmol/L and/or high-density lipoprotein cholesterol (HDL-C) ≤1.0 mmol/L and/or low-density lipoprotein cholesterol (LDL-C) ≥4.1 mmol/L. 20 …”