Lipoprotein(a) and risk of sudden cardiac death in middle-aged Finnish men: A new prospective cohort study

Abstract

Link to publication record in Explore Bristol Research PDF-document This is the author accepted manuscript (AAM). The final published version (version of record) is available online via Elsevier at http://www.sciencedirect.com/science/article/pii/S0167527316310774. Please refer to any applicable terms of use of the publisher. University of Bristol -Explore Bristol Research General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Finland, supported the Kuopio Ischemic Heart Disease Study. These sources had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. 2 Conflicts of interest:The authors report no relationships that could be construed as a conflict of interest.Keywords: Lipoprotein(a); risk factor; risk prediction; sudden cardiac death Lipoprotein(a) levels were log-linearly associated with risk of SCD. In analyses adjusted for established risk factors, the HR (95% CI) for SCD per 1 standard deviation (3.56-fold) higher baseline loge Lp(a) was 1.24 (1.05-1.47; P = 0.013). This remained consistent on further adjustment for alcohol consumption, resting heart rate, lipids, and C-reactive protein 1.23 (1.04-1.46; P = 0.018). HRs remained unchanged after accounting for incident coronary events and did not vary importantly in several relevant clinical subgroups. Adding Lp(a) to a SCD risk prediction model did not significantly improve risk discrimination beyond established risk factors, but improved the continuous net reclassification 30.2% (1.1 to 59.2%, P=0.042).Conclusions: Available evidence shows a continuous and independent association between Lp(a) levels and risk of SCD. Further research is needed to replicate these findings.

Circulating Total Bilirubin and Future Risk of Hypertension in the General Population: The Prevention of Renal and Vascular End‐Stage Disease (PREVEND) Prospective Study and a Mendelian Randomization Approach

“…33 To characterize the shape of the association between total bilirubin and hypertension risk, hazard ratios estimated within quartiles of baseline total bilirubin levels relative to the bottom quartile were plotted against mean log e total bilirubin levels in each quartile using floating absolute risks, 34 details of which have been described previously. 35 Subsidiary analyses involved fitting multivariate-adjusted fractional polynomial models. Total bilirubin was modeled as both continuous (per 1-SD higher log e total bilirubin levels) and categorical (quartiles defined according to the baseline distribution of total bilirubin level) variables.…”

“…Cox proportional hazards models were used to assess the association between total bilirubin and incident hypertension risk after confirmation of no major departure from the proportionality of hazards assumptions using Schoenfeld residuals . To characterize the shape of the association between total bilirubin and hypertension risk, hazard ratios estimated within quartiles of baseline total bilirubin levels relative to the bottom quartile were plotted against mean log e total bilirubin levels in each quartile using floating absolute risks, details of which have been described previously . Subsidiary analyses involved fitting multivariate‐adjusted fractional polynomial models.…”

Combined Effect of Sauna Bathing and Cardiorespiratory Fitness on the Risk of Sudden Cardiac Deaths in Caucasian Men: A Long-term Prospective Cohort Study

“…A detailed report of recruitment methods for the KIHD study has been described in previous papers. 21,23 A representative sample of 3433 randomly selected potentially eligible men were invited for screening examinations carried out between March 1984 and December 1989. Of this number, 3235 were found to be eligible and 2682 (78%) provided consent to participate in the study.…”

Lipoprotein(a) and mortality—a high risk relationship

“…The Lp(a) concentration appeared with limited strength as a predictive test of longterm mortality in subjects with a high cardiovascular risk profile (AUC = 0.63, 95% CI [0.50-0.76], p = 0.049) [21]. The matchable Kuopio Ischemic Heart Disease study followed a cohort of 1881 Finnish men aged 42-61 years also over a median period of 24.7 years [22]. Cumulative hazard curves demonstrated a greater risk of sudden cardiac death, which is a particular aspect of cardiovascular mortality in the top quartile of Lp(a) levels compared to those in the bottom quartile (p = 0.032 for log-rank test).…”