Lipoprotein(a) as predictor of coronary artery disease and myocardial infarction in a multi-ethnic Asian population

Abstract

Background and aims: The role of Lp(a) in multi-ethnic Asian populations with coronary artery disease (CAD) has not been well established. The aims of this study were (i) to investigate whether Lp(a) is a predictor of CAD, and (ii) amongst patients with CAD, to ascertain whether Lp(a) is a predictor of acute myocardial infarction (AMI) and severity of CAD. Methods: We compared three cardiovascular phenotypes from patients recruited at coronary angiography. CAD was defined as ≥50% coronary artery stenosis and subdivided into a group with AMI history (CAD+AMI+) and a group without (CAD+AMI-). Minimal CAD group (CAD-) was defined as normal or <30% coronary artery stenosis and no AMI. The severity of CAD was defined using the modified Gensini score. Results: We studied 2025 patients comprising 94.5% men and 61.4% of Chinese ethnicity. The median Lp(a) level was highest in CAD+AMI+, followed by CAD+AMI-and CAD-(26.2, 20.1, and 15.8 nmol/L respectively). Similarly, the frequency of patients with Lp(a) ≥120 nmol/L were in the same order (11.8%, 9.1% and 2.4%). Lp (a) levels were highest among Asian Indians, followed by Malays and Chinese patients (p < 0.001). Lp(a) levels and Lp(a) ≥120 nmol/L were significant predictors of CAD (Odds ratio (OR) = 1.12 per 10 nmol/L increment, p < 0.001, and OR = 5.41 p = 0.004 respectively). Among patients with CAD, higher Lp(a) levels were associated with increased AMI risk (OR = 1.02 per 10 nmol/L increment, p = 0.024). Lp(a) ≥120 nmol/L was positively associated with CAD severity (p = 0.020). Conclusions: Plasma Lp(a) concentration is a positive predictor of CAD and AMI in a mostly male South East Asian population.

Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement

“…15,16 While these data predominantly relate to White populations, there is evidence that elevated Lp(a) is also a risk factor for ASCVD in other ethnic groups. 20,22,23,[122][123][124][125] The UK Biobank showed very similar relationships between Lp(a) and ASCVD risk in White, Black, and South Asian individuals 20 (Figure 2C and D), consistent with findings from the ARIC study, 22 MESA study, 122 and INTERHEART study. 23 Given limited data in non-White populations, however, further study is needed.…”

Familial Hypercholesterolemia and Elevated Lipoprotein(a): Cascade Testing and Other Implications for Contextual Models of Care

“…The relationship between Lp(a) genetics and concentration varies with ethnicity ( Dumitrescu et al, 2011 ; Paré et al, 2019 ). Higher Lp(a) concentrations are observed among people of African descent and Indians, whereas lower concentrations are reported in Chinese and Hispanic populations ( Enkhmaa et al, 2016 ; Paré et al, 2019 ; Loh et al, 2021 ; Patel et al, 2021 ). Studies, in general, support the clinical use of Lp(a) rather than apo(a) isoforms or single nucleotide polymorphisms (SNPs) in predicting the risk of ASCVD ( Paré et al, 2019 ; Trinder et al, 2020a ; Page et al, 2020 ).…”

“…An early meta-analysis by the Emerging Risk Factors Collaboration of 126,634 people without prior history of CAD or stroke at baseline showed a curvilinear relationship between Lp(a) and cardiovascular outcomes, with the highest risk of CAD and ischaemic stroke being seen at extremely high Lp(a) levels ( Emerging Risk Factors et al, 2009 ). Extremely high plasma Lp(a) concentrations (>95th percentile) are associated with the highest risk of ASCVD ( Kamstrup et al, 2008 ; Burgess et al, 2018 ; Loh et al, 2021 ), CAVD ( Kamstrup et al, 2014 ; Guddeti et al, 2020 ), and heart failure ( Kamstrup and Nordestgaard, 2016 ) in the general population. Mendelian randomization studies employing polygenic risk scores suggest that an extremely elevated Lp(a) (>430 nmol/L or >180 mg/dL) is a risk factor for ASCVD equivalent to HeFH ( Burgess et al, 2018 ; Trinder et al, 2020a ).…”

Prediction of Coronary Artery Disease using Artificial Intelligence – A Systematic Literature Review

“…Total carotid plaque area outperformed risk scores and well-established risk variables in predicting incident CAD. Loh, W. J et al, [87] have explored the hypothesis that Lp(a) predicts CAD in a South East Asian population. They have also looked into whether or not Lp(a) is a predictor of acute myocardial infarction (AMI) and severity of coronary artery stenosis among individuals with existing CAD.…”