Independent Association of Lipoprotein(a) and Coronary Artery Calcification With Atherosclerotic Cardiovascular Risk

Elevated lipoprotein(a) [Lp(a)] and coronary artery calcium (CAC) score are individually associated with increased atherosclerotic cardiovascular disease (ASCVD) risk but have not been studied in combination. This study sought to investigate the independent and joint association of Lp(a) and CAC wit...

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Vydáno v:Journal of the American College of Cardiology Ročník 79; číslo 8; s. 757
Hlavní autoři: Mehta, Anurag, Vasquez, Nestor, Ayers, Colby R, Patel, Jaideep, Hooda, Ananya, Khera, Amit, Blumenthal, Roger S, Shapiro, Michael D, Rodriguez, Carlos J, Tsai, Michael Y, Sperling, Laurence S, Virani, Salim S, Blaha, Michael J, Joshi, Parag H
Médium: Journal Article
Jazyk:angličtina
Vydáno: United States 01.03.2022
Témata:
Asymptomatic Diseases - epidemiology
Coronary Artery Disease - epidemiology
Coronary Artery Disease - prevention & control
Coronary Vessels - pathology
Ethnicity
Female
Heart Disease Risk Factors
Humans
Lipoprotein(a) - blood
Male
Middle Aged
Multidetector Computed Tomography - methods
Multidetector Computed Tomography - statistics & numerical data
Primary Prevention
Risk Factors
United States - epidemiology
Vascular Calcification - blood
Vascular Calcification - epidemiology
Vascular Calcification - pathology
United States
coronary artery calcium
atherosclerotic cardiovascular disease
primary cardiovascular disease prevention
lipoprotein(a)
ISSN:1558-3597, 1558-3597
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Shrnutí:Elevated lipoprotein(a) [Lp(a)] and coronary artery calcium (CAC) score are individually associated with increased atherosclerotic cardiovascular disease (ASCVD) risk but have not been studied in combination. This study sought to investigate the independent and joint association of Lp(a) and CAC with ASCVD risk. Plasma Lp(a) and CAC were measured at enrollment among asymptomatic participants of the MESA (Multi-Ethnic Study of Atherosclerosis) (n = 4,512) and DHS (Dallas Heart Study) (n = 2,078) cohorts. Elevated Lp(a) was defined as the highest race-specific quintile, and 3 CAC score categories were studied (0, 1-99, and ≥100). Associations of Lp(a) and CAC with ASCVD risk were evaluated using risk factor-adjusted Cox regression models. Among MESA participants (61.9 years of age, 52.5% women, 36.8% White, 29.3% Black, 22.2% Hispanic, and 11.7% Chinese), 476 incident ASCVD events were observed during 13.2 years of follow-up. Elevated Lp(a) and CAC score (1-99 and ≥100) were independently associated with ASCVD risk (HR: 1.29; 95% CI: 1.04-1.61; HR: 1.68; 95% CI: 1.30-2.16; and HR: 2.66; 95% CI: 2.07-3.43, respectively), and Lp(a)-by-CAC interaction was not noted. Compared with participants with nonelevated Lp(a) and CAC = 0, those with elevated Lp(a) and CAC ≥100 were at the highest risk (HR: 4.71; 95% CI: 3.01-7.40), and those with elevated Lp(a) and CAC = 0 were at a similar risk (HR: 1.31; 95% CI: 0.73-2.35). Similar findings were observed when guideline-recommended Lp(a) and CAC thresholds were considered, and findings were replicated in the DHS. Lp(a) and CAC are independently associated with ASCVD risk and may be useful concurrently for guiding primary prevention therapy decisions.
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ISSN:1558-3597
1558-3597
DOI:10.1016/j.jacc.2021.11.058