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

Abstract

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.

Lipoprotein (a) and lipid-lowering treatment from the perspective of a cardiac surgeon. An impact on the prognosis in patients with aortic valve replacement and after heart transplantation

“…Based on information from Refs. [ [1] , [2] , [3] , [4] , [5] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [32] , [33] , [34] , [35] , [36] , [37] , [44] , [45] , [46] , [47] , [48] , [49] , [50] ]. The elements of the figure were created using SERVIER MEDICAL ART (CC BY 4.0).…”

“…Increased Lp(a) levels are associated with a higher risk of HF, especially HFpEF, by 109–153 % [ 32 ]. Elevated Lp(a) level is associated with higher risk of CV mortality in HFrEF patients (HR = 1.22; 95 % CI: 1.04–1.64) [ 33 ].…”

Synergistic effect of lipoprotein(a) and high-sensitivity C-reactive protein on the risk of all-cause and cardiovascular death in patients with acute myocardial infarction: a large prospective cohort study

“…Some studies report an increased risk of IHD and MI with high Lp(a) levels in individuals with CRP ≥ 2mg/L, although findings are not consistently significant (33)(34)(35)(36). Large cohort studies have provided mixed results on the association between Lp(a), Hs-CRP, with cardiovascular risk, suggesting variability by race, sex, and specific cardiovascular outcomes (37)(38)(39)(40)(41). Notably, in certain populations, elevated Lp(a) levels combined with high Hs-CRP significantly correlate with increased risks of major adverse cardiovascular events (MACE), heart failure rehospitalization, and cardiovascular death, while in other populations, such associations have not been observed (38)(39)(40)(41).…”

“…Large cohort studies have provided mixed results on the association between Lp(a), Hs-CRP, with cardiovascular risk, suggesting variability by race, sex, and specific cardiovascular outcomes (37)(38)(39)(40)(41). Notably, in certain populations, elevated Lp(a) levels combined with high Hs-CRP significantly correlate with increased risks of major adverse cardiovascular events (MACE), heart failure rehospitalization, and cardiovascular death, while in other populations, such associations have not been observed (38)(39)(40)(41). Furthermore, adding other biomarkers like residual cholesterol or D-dimer to the Lp(a) and Hs-CRP combination has shown that the highest levels of these markers correlate with the greatest risk of adverse outcomes in CHD patients (42,43).…”

Are we seeing the light at the end of the tunnel for high lipoprotein(a)? Lipoprotein(a)

“…Likewise, elevated Lp(a) (≥30 mg/dL) is associated with higher serum N-terminal pro-B natriuretic peptide levels and lower left ventricular ejection fraction at follow-up (54). Increased cardiovascular mortality and hospitalization rates are reported within the first year of the diagnosis of heart failure in those with high Lp(a) (≥30 mg/dL) (55).…”