High-Sensitivity C-Reactive Protein Modifies the Cardiovascular Risk of Lipoprotein(a)

Zhang, Wei; Speiser, Jaime L.; Ye, Fan; Tsai, Michael Y.; Cainzos‐Achirica, Miguel; Nasir, Khurram; Herrington, David M.; Shapiro, Michael D.

doi:10.1016/j.jacc.2021.07.016

Cited by 100 publications

(60 citation statements)

References 31 publications

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“…One recent study showed that in the US community populations, Lp(a)‐associated atherosclerotic cardiovascular risk was observed only in patients with elevated Hs‐CRP level. 17 These findings together suggest that individuals with elevated Lp(a) and enhanced systemic inflammation had a high cardiovascular mortality risk and thus may merit a close surveillance and aggressive cardiovascular risk management.…”

Section: Discussionmentioning

confidence: 86%

“…Importantly, two recent studies indicated that the relationship between elevated Lp(a) level and cardiovascular event in community populations was modified by baseline high‐sensitivity C‐reactive protein (Hs‐CRP) level. 17 , 18 Therefore, we herein evaluated the relationship between serum Lp(a) level and 1 year risk of HF rehospitalization and cardiovascular mortality in HFrEF patients. In addition, we evaluated whether the relationship would be modified by baseline systemic inflammation, which may provide information on the mechanisms underlying the association between elevated Lp(a) level and cardiovascular risk in HFrEF populations.…”

Section: Introductionmentioning

confidence: 99%

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Association of lipoprotein (a) and 1 year prognosis in patients with heart failure with reduced ejection fraction

Liu

Shen

et al. 2022

ESC Heart Failure

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AimCurrent study was to evaluate relationship between baseline serum lipoprotein (a) [Lp(a)] level and prognosis in patients with heart failure with reduced ejection fraction (HFrEF) and to explore whether the relationship would be modified by baseline high-sensitivity C-reactive protein (Hs-CRP) level. Methods and resultsThis is an observational prospective study. HFrEF patients from outpatient clinic were consecutively recruited (n = 362). Based on Lp(a) cutoff (30 mg/dL), patients were divided into normal and high Lp(a) groups; and based on Hs-CRP cutoff (3 mg/dL), patients were divided into low-degree and high-degree groups. The 1 year rate of HF rehospitalization was similar between these two groups (22.7% vs. 24.1%, P = 0.18), while the 1 year rate of cardiovascular mortality was higher in Lp(a) ≥ 30 mg/dL versus Lp(a) < 30 mg/dL groups (20.3% vs. 13.3%, P = 0.009), as was composite endpoint (44.4% vs. 36.0%, P < 0.001). After adjusting for covariates, elevated Lp(a) level remained associated with a higher risk of cardiovascular mortality [hazard ratio (HR) 1.22 and 95% confidence interval (CI) 1.04-1.64, P = 0.02] and composite endpoint (HR 1.38 and 95% CI 1.16-2.01, P = 0.006). In Hs-CRP ≥ 3 mg/dL group, elevated Lp(a) level was associated with HF rehospitalization, cardiovascular mortality, and composite endpoint, which was not observed in Hs-CRP < 3 mg/dL group. The association was greater for cardiovascular mortality (P-interaction = 0.04) and composite endpoint (P-interaction = 0.02) in Hs-CRP ≥ 3 mg/ dL versus Hs-CRP < 3 mg/dL groups. Conclusion Elevated Lp(a) level is associated with higher risk of cardiovascular mortality in HFrEF patients, which might be due to enhanced systemic inflammation.

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Section: Discussionmentioning

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Association of lipoprotein (a) and 1 year prognosis in patients with heart failure with reduced ejection fraction

Liu

Shen

et al. 2022

ESC Heart Failure

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“…When troponin-I was added to the institutional inspection items as a continuous variable related to cardiovascular disease, the total number of participants was reduced by 80%, thus, hs-CRP, which has a relatively high test frequency, was added. For hs-CRP less than 2 mg/L, no significant risk of cardiovascular disease was observed at any Lp(a) level, however, when accompanied by an increase in Lp(a) above 2 mg/L, a significant cardiovascular risk was found [17].…”

Section: Discussionmentioning

confidence: 90%

Relationship between Lipoprotein(a) and Dyslipidemia in the Elderly over 60 Years

Seo

Shin

2022

Korean J Clin Lab Sci

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The relationship between lipoprotein(a) and dyslipidemia is not clear. This study was therefore undertaken to investigate the relationship between lipoprotein(a) and dyslipidemia in elderly patients over 60 years. From 2014 to 2020, a total of 2,580 adults aged 60 years or older (73.31±7.24 years, 1,954 males) were enrolled in the study. The patients had checked into a general hospital, and data were obtained for lipoprotein(a), LDL-C, TG, HDL-C, hs-CRP, HbA1c, sex, age, BMI, dyslipidemia diagnosis, and use of lipid-lowering agents. BMI and HbA1c showed no correlation with lipoprotein(a), but hs-CRP (r=0.138), LDL-C (r=0.097), HDL-C (r=-0.089), TG (r=-0.073), and age (r=0.072) were significantly correlated to lipoprotein(a). The partial correlation between lipoprotein(a) and LDL-C, which was adjusted for variables, was significant only in the male gender (r=0.158, P＜0.001). As the odds ratio of the 4 th quartile of lipoprotein(a) (OR=1.376, 95% CI=1.038∼1.822) for dyslipidemia was found to be significant in this study when the level of LDL-C, the primary target, could not be reduced even by taking lipid-lowering drugs, we propose that lipoprotein(a) should also be included among the several factors considered as secondary targets. Our results indicate that studies on various lipid factors considering the sex, age, types and use of lipid-lowering agents, are warranted.

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“…In the MESA (Multi‐Ethnic Study of Atherosclerosis), the multivariable‐adjusted HR for incident ASCVD per 1‐unit higher log‐transformed lipoprotein(a) was 1.32 (95% CI, 1.05–1.65) among participants with hs‐CRP ≥2 mg/L, and 1.02 (95% CI, 0.81–1.27) in those with hs‐CRP <2 mg/L ( P value comparing HRs, 0.04). 20 However, 95% CIs were wide and the MESA only included participants without clinical ASCVD at baseline. Results from the current analysis of a population‐based cohort of US adults with a history of ASCVD do not support that higher lipoprotein(a) is associated with an increased risk for CHD events only among those with hs‐CRP ≥2 mg/L.…”

Section: Discussionmentioning

confidence: 99%

“… 15 Prior studies suggest that the association between lipoprotein(a) and ASCVD events may differ between adults taking versus not taking a statin, 16 , 17 , 18 and among those with versus without high levels of hs‐CRP (high‐sensitivity C‐reactive protein). 19 , 20 In an exploratory analysis, we determined whether statin use or hs‐CRP levels modify the association of lipoprotein(a) with CHD and ischemic stroke events in adults with ASCVD.…”

mentioning

confidence: 99%

Lipoprotein(a) and the Risk for Coronary Heart Disease and Ischemic Stroke Events Among Black and White Adults With Cardiovascular Disease

Colantonio

Bittner

Safford

et al. 2022

JAHA

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Background It is unclear whether lipoprotein(a) is associated with coronary heart disease (CHD) and ischemic stroke events in White and Black adults with atherosclerotic cardiovascular disease (ASCVD). Methods and Results We conducted a case‐cohort analysis, including Black and White REGARDS (Reasons for Geographic and Racial Differences in Stroke) study participants ≥45 years of age with prevalent ASCVD (ie, CHD or stroke) at baseline between 2003 and 2007. Baseline lipoprotein(a) molar concentration was measured in participants with ASCVD who experienced a CHD event by December 2017 (n=1166) or an ischemic stroke by September 2019 (n=492) and in a random subcohort of participants with prevalent ASCVD (n=1948). The hazard ratio (HR) for CHD events per 1 SD (1.5 units) higher log‐transformed lipoprotein(a) was 1.26 (95% CI, 1.02–1.56) among Black participants and 1.16 (95% CI, 1.02–1.31) among White participants ( P value comparing HRs, 0.485). The HR for CHD events per 1 SD higher log‐lipoprotein(a) within subgroups with hs‐CRP (high‐sensitivity C‐reactive protein) ≥2 and <2 mg/L was 1.31 (95% CI, 0.99–1.73) and 1.23 (95% CI, 0.85–1.80), respectively ( P value comparing HRs, 0.836), among Black participants, and 1.07 (95% CI, 0.91–1.27) and 1.36 (95% CI, 1.10–1.70), respectively ( P value comparing HRs, 0.088), among White participants. There was no evidence that the association between lipoprotein(a) and CHD events differed by statin use. There was no evidence of an association between lipoprotein(a) and ischemic stroke events among Black or White participants. Conclusions Higher lipoprotein(a) levels were associated with an increased risk for CHD events in Black and White adults with ASCVD.

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High-Sensitivity C-Reactive Protein Modifies the Cardiovascular Risk of Lipoprotein(a)

Cited by 100 publications

References 31 publications

Association of lipoprotein (a) and 1 year prognosis in patients with heart failure with reduced ejection fraction

Association of lipoprotein (a) and 1 year prognosis in patients with heart failure with reduced ejection fraction

Relationship between Lipoprotein(a) and Dyslipidemia in the Elderly over 60 Years

Lipoprotein(a) and the Risk for Coronary Heart Disease and Ischemic Stroke Events Among Black and White Adults With Cardiovascular Disease

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