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

Abstract

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.

Vitamin D supplementation and major cardiovascular events: D-Health randomised controlled trial

“…However, the number of stroke events was relatively low, particularly when haemorrhagic stroke, which has different pathophysiology, was excluded; therefore, the confidence intervals were wide and consistent with benefit or harm. Moreover, there are several examples where associations with myocardial infarction and stroke differ, [21][22][23] so this finding is not entirely unexpected.…”

“…There was no interaction with elapsed time for these outcomes (supplementary figs 15 and 17). The intervention had no apparent effect on stroke (0.99, 0.80 to 1.23; table 2, supplementary fig [18][19][20][21][22][23]. In exploratory analyses of myocardial infarction and coronary revascularisation, we did not find evidence of interactions with baseline statin and other cardiovascular drug use (supplementary table 6).…”

Lipoprotein(a) Testing Trends in a Large Academic Health System in the United States

“…Elevated lipoprotein(a) is a well‐established risk factor for multiple cardiovascular diseases (CVDs), especially coronary artery disease and aortic stenosis (AS). 1 Lipoprotein(a) is also associated with ischemic stroke, 2 , 3 peripheral vascular disease (PVD), 4 and heart failure (HF). 5 The accumulation of epidemiologic and genetic studies strongly supports a causal role for lipoprotein(a) in CVD in diverse populations, even with low levels of low‐density lipoprotein cholesterol.…”

Lipoprotein(a): Evidence for Role as a Causal Risk Factor in Cardiovascular Disease and Emerging Therapies

“…The normal physiological function of Lp(a) is unknown [ 1 ]. However, Lp(a) is associated with increased risk for several cardiovascular diseases (CVD), including coronary artery disease (CAD)/atherosclerotic cardiovascular disease (ASCVD) [ 2 ], aortic stenosis/calcific aortic valve disease (AS/CAVD) [ 6 ], ischemic stroke [ 7 , 8 ], heart failure [ 9 ], atrial fibrillation [ 10 ], and peripheral arterial disease [ 11 ]. Lp(a) is associated with risk for CAD through multiple mechanisms ( Figure 1 ) including atherogenesis mediated by apoB [ 12 ], vascular inflammation mediated by its carriage of oxidized phospholipids (OxPL) [ 13 , 14 , 15 , 16 ], and anti-fibrinolytic effects that may be related to the homology of apo(a) with plasminogen [ 17 ].…”