Low lipoprotein(a) concentration is associated with atrial fibrillation: a large retrospective cohort study

Abstract

Background and aims The role of serum lipoprotein(a) [Lp(a)] levels in atrial fibrillation (AF) is still uncertain, especially in the Chinese population. Here, we aimed to elucidate the potential relationship between Lp(a) quantiles and AF. Methods All data were collected through inpatients with electronic health records from the Second Affiliated Hospital of Nanchang University, Jiangxi Province, China. The propensity score matching (PSM) method was used to match control and case groups. Interactions between AF, Lp(a) quantiles, and other clinical indices were analyzed by logistic regression and stratified analysis. Statistical analyses were performed with IBM SPSS statistical software and R software. Results From 2017 to 2021, 4,511 patients with AF and 9,022 patients without AF were 1:2 matched by the propensity score matching method. A total of 46.9% of the study group was women, and the baseline mean age was 65 years. The AF group exhibited lower median Lp(a) than the non-AF group (15.95 vs. 16.90 mg/dL; P < 0.001). Based on the Lp(a) quantiles, the study population was divided into four groups: Q1 (≤ 8.71 mg/dL), Q2 (8.71–16.54 mg/dL), Q3 (16.54–32.42 mg/dL) and Q4 (> 32.42 mg/dL). The AF prevalence of each group decreased from 34.2% (Q1) to 30.9% (Q4) (P < 0.001). Lp(a) quantiles 1–3 significantly increased AF to 1.162-fold (1.049–1.286), 1.198-fold (1.083–1.327), and 1.111-fold (1.003–1.231) in the unadjusted logistic regression model, respectively. In the adjusted model, Lp(a) < 32.42 mg/dL still showed a significant inverse association with AF. In the stratified analysis, Lp(a) levels in female patients exhibited a significant negative correlation with AF (OR of Q1: 1.394[1.194–1.626], P = 0.001). Age and hypertension did not affect the adverse correlation. Conclusion Low circulating Lp(a) levels were associated with AF, especially in the female Han population, suggesting that Lp(a) may be useful for risk stratification of AF in female individuals.

The association between lipoprotein(a) and atrial fibrillation: A systemic review and meta‐analysis

“…Four studies have different stratification of the levels of Lp(a). 25,26,30,31 This meta-analysis showed that Lp(a) was not associated with new-onset AF (HR = 1.45, 95% CI: 0.57-3.67, p = .432; I 2 = 73.6%) (Figure 1). In addition, genetically elevated Lp(a) was not associated with the risk of atrial fibrillation (OR = 1.00, 95% CI: 1.00-1.00, p = .461; I 2 = 72.6%) (Figure 2).…”

“…Therefore, nine studies were included in the final analysis. 11,13,20,25,26,[30][31][32][33] Four were prospective cohort studies 11,23,24,28 and one was retrospective in design. 31 Four included studies performed Mendelian randomization (MR) analysis for Lp(a) and AF.…”

“…11,13,20,25,26,[30][31][32][33] Four were prospective cohort studies 11,23,24,28 and one was retrospective in design. 31 Four included studies performed Mendelian randomization (MR) analysis for Lp(a) and AF. 13,20,32,33 Data on associations between the singlenucleotide polymorphisms (SNPs) for Lp(a) level and AF were obtained from the online report on the platform of genome-wide association studies (GWAS).…”

“…Also, higher Lp(a) levels may be inversely associated with the risk of developing AF compared to those with lower levels. 25,26,31,32…”

“…The study also indicated that an Lp(a) level lower than 32.42 mg/dL could be a potential risk factor for AF. 31 Subsequently, both studies mentioned above suggested that Lp(a) can be used as a helpful marker for AF risk stratification.…”