Coronary Artery Disease: Optimal Lipoprotein(a) for Survival-Lower Is Better? A Large Cohort With 43,647 Patients

作者：Liu, Jin; Liu, Liwei; Wang, Bo; Chen, Shiqun; Liu, Buyun; Liang, Jingjing; Huang, Haozhang; Li, Qiang; Lun, Zhubin; Ying, Ming; Chen, Guanzhong; Huang, Zhidong; Xu, Danyuan; Yan, Xiaoming; Zhu, Tingting; Tadesse, Girmaw Abebe; Tan, Ning; Chen, Jiyan; Liu, Yong^*

来源：Frontiers in Cardiovascular Medicine, 2021, 8: 670859.

DOI：10.3389/fcvm.2021.670859

• coronary artery disease
• baseline lipoprotein(a)
• long-term all-cause mortality
• percutaneous coronary intervention
• coronary angiography

Background: A high level of lipoprotein(a) can lead to a high risk of cardiovascular events or mortality. However, the association of moderately elevated lipoprotein(a) levels (>= 15 mg/dL) with long-term prognosis among patients with coronary artery disease (CAD) is still uncertain. Hence, we aim to systematically analyzed the relevance of baseline plasma lipoprotein(a) levels to long-term mortality in a large cohort of CAD patients. @@@ Methods: We obtained data from 43,647 patients who were diagnosed with CAD and had follow-up information from January 2007 to December 2018. The patients were divided into two groups (< 15 and >= 15 mg/dL). The primary endpoint was long-term all-cause death. Kaplan-Meier curve analysis and Cox proportional hazards models were used to investigate the association between moderately elevated baseline lipoprotein(a) levels (>= 15 mg/dL) and long-term all-cause mortality. @@@ Results: During a median follow-up of 5.04 years, 3,941 (18.1%) patients died. We observed a linear association between lipoprotein(a) levels and long-term all-cause mortality. Compared with lipoprotein(a) concentrations < 15 mg/dL, lipoprotein(a) >= 15 mg/dL was associated with a significantly higher risk of all-cause mortality [adjusted hazard ratio (aHR) 1.10, 95%CI: 1.04-1.16, P-values = 0.001). Similar results were found for the subgroup analysis of non-acute myocardial infarction, non-percutaneous coronary intervention, chronic heart failure, diabetes mellitus, or non-chronic kidney diseases. @@@ Conclusion: Moderately elevated baseline plasma lipoprotein(a) levels (>= 15 mg/dL) are significantly associated with higher all-cause mortality in patients with CAD. Our finding provides a rationale for testing the lipoprotein(a)-reducing hypothesis with lower targets (even < 15 mg/dL) in CAD outcome trials.

• 单位
  广东省心血管病研究所; 南方医科大学; 广东省人民医院; y