Author + information
Background: In patients with atherosclerotic cardiovascular disease (ASCVD), the relationship of lipoprotein(a) [Lp(a)] levels with ASCVD outcomes when LDL-C levels are controlled remains unclear.
Methods: We studied 3,196 patients with ASCVD in the AIM-HIGH trial, all of whom were on statin therapy. Recurrent ASCVD events included death from coronary heart disease, nonfatal myocardial infarction, ischemic stroke, hospitalization for suspected acute coronary syndrome, or symptom-driven coronary or cerebral revascularization. We calculated rates of new ASCVD events (per 1000 person-years) according to LDL-C categories (<70, 70-99, and >99mg/dl) and Lp(a) tertiles. Adjusted Cox regression was performed with the lowest LDL-C/Lp(a) category as reference.
Results: Over a mean follow-up of 3.8 years, the overall ASCVD event rate was 49.6 per 1000-person years; higher Lp(a) levels were associated with increased ASCVD event rates across all LDL-C categories (Figure). LDL-C levels did not predict ASCVD event rates (HR 1.00, p > 0.05), but Lp(a) levels were a significant predictor of ASCVD events (HR 1.31 per standard deviation, p < 0.01). Compared with the reference group, adjusted HRs for the highest tertiles of Lp(a) were 1.53 (p < 0.05), 1.60 (p < 0.05), and 1.90 (p = 0.06) in the LDL-C groups of <70, 70-99, and >99mg/dl, respectively.
Conclusions: In patients with a history of ASCVD on statins, despite being at target LDL-C levels, elevated Lp(a) levels remain associated with increased ASCVD residual risk.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Advances in Cholesterol Measurement and Management
Abstract Category: 32. Prevention: Clinical
Presentation Number: 1106-067
- 2017 American College of Cardiology Foundation