Background: Low-density lipoprotein cholesterol (LDL-C) and lipoprotein(a) (Lp[a]) levels are independently associated with atherosclerotic cardiovascular disease (ASCVD). However, the relationship between Lp(a) level, LDL-C level, and ASCVD risk at different thresholds is not well defined.
Methods: A participant-level meta-analysis of 27 658 participants enrolled in 6 placebo-controlled statin trials was performed to assess the association of LDL-C and Lp(a) levels with risk of fatal or nonfatal coronary heart disease events, stroke, or any coronary or carotid revascularization (ASCVD). The multivariable-adjusted association between baseline Lp(a) level and ASCVD risk was modeled continuously using generalized additive models, and the association between baseline LDL-C level and ASCVD risk by baseline Lp(a) level by Cox proportional hazards models with random effects. The joint association between Lp(a) level and statin-achieved LDL-C level with ASCVD risk was evaluated using Cox proportional hazards models.
Results: Compared with an Lp(a) level of 5 mg/dL, increasing levels of Lp(a) were log-linearly associated with ASCVD risk in statin- and placebo-treated patients. Among statin-treated individuals, those with Lp(a) level >50 mg/dL (≈125 nmol/L) had increased risk across all quartiles of achieved LDL-C level and absolute change in LDL-C level. Even among those with the lowest quartile of achieved LDL-C level (3.1-77.0 mg/dL), those with Lp(a) level >50 mg/dL had greater ASCVD risk (hazard ratio, 1.38 [95% CI, 1.06-1.79]) than those with Lp(a) level ≤50 mg/dL. The greatest risk was observed with both Lp(a) level >50 mg/dL and LDL-C level in the fourth quartile (hazard ratio, 1.90 [95% CI, 1.46-2.48]).
Conclusions: These findings demonstrate the independent and additive nature of Lp(a) and LDL-C levels for ASCVD risk, and that LDL-C lowering does not fully offset Lp(a)-mediated risk.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1161/CIRCULATIONAHA.124.069556 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Role of aspirin in the primary prevention of cardiovascular disease in patients with hyperlipoproteinaemia(a).
Drugs Context
December 2024
2nd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece.
Lipoprotein(a) [Lp(a)] is a well-established cardiovascular disease (CVD) risk factor with elevated Lp(a) levels contributing to a higher incidence of atherosclerotic CVD (ASCVD). However, no Lp(a)-specific interventions are currently available in the primary CVD prevention in individuals with elevated Lp(a) levels. RNA-based therapies targeting Lp(a) are under investigation in phase III clinical trials.
View Article and Find Full Text PDFLysoglycerophospholipid metabolism alterations associated with ambient fine particulate matter exposure: Insights into the pro-atherosclerotic effects.
Environ Pollut
January 2025
SKL-ESPC & SEPKL-AERM, College of Environmental Sciences and Engineering, and Center for Environment and Health, Peking University, Beijing, China. Electronic address:
The biological pathways connecting ambient fine particulate matter (PM)-induced initial adverse effects to the development of atherosclerotic cardiovascular diseases are not fully understood. We hypothesize that lysoglycerophospholipids (LysoGPLs) are pivotal mediators of atherosclerosis induced by exposure to PM. This study investigated the changes of LysoGPLs in response to PM exposure and the mediation role of LysoGPLs in the pro-atherosclerotic effects of PM exposure.
View Article and Find Full Text PDFNew Approaches to Lipoproteins for the Prevention of Cardiovascular Events.
J Atheroscler Thromb
December 2024
Victorian Heart Institute, Monash University.
Article Synopsis
- Atherosclerotic cardiovascular disease (ASCVD) is a major global health issue, with high levels of low-density lipoprotein cholesterol (LDL-C) linked to increased cardiovascular risk.
- Numerous studies confirm that lipid-lowering therapies (LLT) are effective; however, there is a gap between guidelines and actual clinical practice regarding LDL-C targets.
- The review suggests new strategies beyond traditional LDL-C management, such as combination therapies and emerging drugs, while also introducing the potential use of polygenic risk scores for personalized treatment approaches in ASCVD prevention.
Identifying subgroups of individuals based on their epistemic stance, attachment dimensions and childhood trauma: A latent profile analysis.
J Psychiatr Res
December 2024
Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom; Anna Freud National Centre for Children and Families, London, United Kingdom.
Background: The present study examines the interplay between epistemic stance, attachment dimensions, and childhood trauma in relation to specific demographic factors and mental health outcomes. This study aims to understand how these factors form distinct profiles among individuals, to identify those at risk of mental health concerns.
Method: Latent Profile Analysis (LPA) was employed on a dataset from the general population (n = 500) to identify subgroups of individuals based on their epistemic stance (mistrust and credulity), attachment dimensions, and childhood trauma.
HPV-Associated Gene Signatures in Bladder Cancer: A Comprehensive Prognostic Model and its Implications in Immunotherapy.
Int J Med Sci
January 2025
Department of Urology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong 518033, China.
Evidence increasingly indicates that HPV infection plays a pivotal role in the initiation and progression of bladder cancer (BC). Yet, determining the predictive value of HPV-associated genes in BC remains challenging. We identified differentially expressed HPV-associated genes of BC patients from the TCGA and GEO databases.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!