Association of Lipoprotein(a) Levels With Myocardial Infarction in Patients With Low-Attenuation Plaque
Authors' conclusion
Elevated Lp(a) augmented the risk of MI during 8 years of follow-up, especially in patients with LAP identified by CCTA. The presence of LAP could reinforce the relationship between Lp(a) and future MI occurrence.
Study context
- Population
- Patients with stable chest pain suspected of CAD who underwent coronary CT angiography and Lp(a) measurementderivation cohort
- Participants
- 5,607 patients
- Exposure
- High Lp vs lower Lp, by presence of low-attenuation plaque (LAP) on coronary CT angiography
- Outcome
- Composite of:
- Time to fatal
- Nonfatal MI
- Follow-up
- Median 8.2 years (Q1-Q3: 7.2-9.3 years)
Methodological detailsmulticentre, derivation and validation cohorts, multivariable Cox models
- Multicentre
- Derivation and validation cohorts
- Multivariable Cox models
Main finding
As reported in the abstract
Fatal or nonfatal MI · median follow-up 8.2 years
Elevated Lp(a) levels associated with myocardial infarction (MI) risk (aHR, 95% CI)
aHR 1.91; 95% CI 1.46-2.49
P < 0.001
Observational data: associations, not effects.
Further findings
MI in patients with LAP (subgroup)
- Lp(a) associated with MI in patients with LAP (aHR, 95% CI)
- aHR 3.03; 95% CI 1.92-4.76; P < 0.001
- Pinteraction <0.001 (Lp(a) × LAP)
Mediation of Lp(a)–MI relationship by LAP
- Proportion mediated by LAP
- 73.3% (P < 0.001)
Validation cohort
- Principal findings unchanged in the validation cohort
Original publication
Association of Lipoprotein(a) Levels With Myocardial Infarction in Patients With Low-Attenuation Plaque. J Am Coll Cardiol. Published 7 May 2024. doi:10.
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