Elevated lipoprotein(a) is associated with increased risk for MACE in patients with premature and recurrent atherosclerotic cardiovascular disease: a large real-world cohort study

Résumé fourni par la source

While rates of premature atherosclerotic cardiovascular disease (ASCVD) continue to increase globally, there is rising interest in the causal role of elevated lipoprotein(a) [Lp(a)] in ASCVD risk. However, sparse evidence exists to quantify the risk and burden of future cardiovascular events associated with elevated Lp(a) in patients with premature or recurrent ASCVD. The objective of this analysis was to investigate the risk of major adverse cardiovascular events (MACE) associated with elevated Lp(a) in patients with premature and recurrent ASCVD. This was a retrospective cohort study of patients with ASCVD from the Optum ® de-identified Electronic Health Record database between 01 January 2014‒30 June 2023. Risk and incidence rates of MACE were calculated using adjusted Cox proportional hazard and Poisson models, respectively, stratified by Lp(a) ≥ 150 nmol/L and Lp(a) < 65 nmol/L. Overall, 2684 (premature ASCVD) and 4528 (recurrent ASCVD) patients were identified. Patients with premature ASCVD and Lp(a) ≥ 150 nmol/L had a 20% greater risk of future MACE ( p = 0.005) and 42% more coronary revascularizations ( p = 0.005) overall during follow-up versus patients with Lp(a) < 65 nmol/L. Patients with recurrent ASCVD and Lp(a) ≥ 150 nmol/L had a 14% greater risk of a future MACE ( p = 0.013) and a 26% greater risk of future MI ( p < 0.001), and 38% more MIs ( p < 0.001) overall versus patients with Lp(a) < 65 nmol/L. This analysis highlights the substantial cardiovascular risk and burden associated with elevated Lp(a) in premature and recurrent ASCVD cohorts. These findings bring attention to highly vulnerable patient groups who may benefit from optimized risk management and future Lp(a) intervention. Central illustration. A retrospective cohort study examining the association between elevated Lp(a) and MACE risk in patients with premature or recurrent ASCVD using Optum® de-identified EHR data

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