TY - JOUR
T1 - Association of Lipoprotein (a) and Standard Modifiable Cardiovascular Risk Factors With Incident Myocardial Infarction
T2 - The Mass General Brigham Lp(a) Registry
AU - Shiyovich, Arthur
AU - Berman, Adam N.
AU - Besser, Stephanie A.
AU - Biery, David W.
AU - Kaur, Gurleen
AU - Divakaran, Sanjay
AU - Singh, Avinainder
AU - Huck, Daniel M.
AU - Weber, Brittany
AU - Plutzky, Jorge
AU - Di Carli, Marcelo F.
AU - Nasir, Khurram
AU - Cannon, Christopher
AU - Januzzi, James L.
AU - Bhatt, Deepak L.
AU - Blankstein, Ron
N1 - Publisher Copyright:
© 2024 The Authors.
PY - 2024/5/21
Y1 - 2024/5/21
N2 - BACKGROUND: Lipoprotein (a) [Lp(a)] is a robust predictor of coronary heart disease outcomes, with targeted therapies currently under investigation. We aimed to evaluate the association of high Lp(a) with standard modifiable risk factors (SMuRFs) for incident first acute myocardial infarction (AMI).METHODS AND RESULTS: This retrospective study used the Mass General Brigham Lp(a) Registry, which included patients aged ≥18 years with an Lp(a) measurement between 2000 and 2019. Exclusion criteria were severe kidney dysfunction, malignant neoplasm, and prior known atherosclerotic cardiovascular disease. Diabetes, dyslipidemia, hypertension, and smoking were considered SMuRFs. High Lp(a) was defined as >90th percentile, and low Lp(a) was defined as <50th percentile. The primary outcome was fatal or nonfatal AMI. A combination of natural language processing algorithms,
International Classification of Diseases (
ICD) codes, and laboratory data was used to identify the outcome and covariates. A total of 6238 patients met the eligibility criteria. The median age was 54 (interquartile range, 43-65) years, and 45% were women. Overall, 23.7% had no SMuRFs, and 17.8% had ≥3 SMuRFs. Over a median follow-up of 8.8 (interquartile range, 4.2-12.8) years, the incidence of AMI increased gradually, with higher number of SMuRFs among patients with high (log-rank
P=0.031) and low Lp(a) (log-rank
P<0.001). Across all SMuRF subgroups, the incidence of AMI was significantly higher for patients with high Lp(a) versus low Lp(a). The risk of high Lp(a) was similar to having 2 SMuRFs. Following adjustment for confounders and number of SMuRFs, high Lp(a) remained significantly associated with the primary outcome (hazard ratio, 2.9 [95% CI, 2.0-4.3];
P<0.001).
CONCLUSIONS: Among patients with no prior atherosclerotic cardiovascular disease, high Lp(a) is associated with significantly higher risk for first AMI regardless of the number of SMuRFs.
AB - BACKGROUND: Lipoprotein (a) [Lp(a)] is a robust predictor of coronary heart disease outcomes, with targeted therapies currently under investigation. We aimed to evaluate the association of high Lp(a) with standard modifiable risk factors (SMuRFs) for incident first acute myocardial infarction (AMI).METHODS AND RESULTS: This retrospective study used the Mass General Brigham Lp(a) Registry, which included patients aged ≥18 years with an Lp(a) measurement between 2000 and 2019. Exclusion criteria were severe kidney dysfunction, malignant neoplasm, and prior known atherosclerotic cardiovascular disease. Diabetes, dyslipidemia, hypertension, and smoking were considered SMuRFs. High Lp(a) was defined as >90th percentile, and low Lp(a) was defined as <50th percentile. The primary outcome was fatal or nonfatal AMI. A combination of natural language processing algorithms,
International Classification of Diseases (
ICD) codes, and laboratory data was used to identify the outcome and covariates. A total of 6238 patients met the eligibility criteria. The median age was 54 (interquartile range, 43-65) years, and 45% were women. Overall, 23.7% had no SMuRFs, and 17.8% had ≥3 SMuRFs. Over a median follow-up of 8.8 (interquartile range, 4.2-12.8) years, the incidence of AMI increased gradually, with higher number of SMuRFs among patients with high (log-rank
P=0.031) and low Lp(a) (log-rank
P<0.001). Across all SMuRF subgroups, the incidence of AMI was significantly higher for patients with high Lp(a) versus low Lp(a). The risk of high Lp(a) was similar to having 2 SMuRFs. Following adjustment for confounders and number of SMuRFs, high Lp(a) remained significantly associated with the primary outcome (hazard ratio, 2.9 [95% CI, 2.0-4.3];
P<0.001).
CONCLUSIONS: Among patients with no prior atherosclerotic cardiovascular disease, high Lp(a) is associated with significantly higher risk for first AMI regardless of the number of SMuRFs.
KW - acute myocardial infarction
KW - atherosclerotic cardiovascular disease
KW - lipoprotein (a)
KW - standard modifiable risk factors
KW - Myocardial Infarction/epidemiology
KW - Humans
KW - Middle Aged
KW - Risk Factors
KW - Male
KW - Lipoprotein(a)/blood
KW - Incidence
KW - Female
KW - Registries
KW - Adult
KW - Biomarkers/blood
KW - Retrospective Studies
KW - Aged
KW - Heart Disease Risk Factors
KW - Risk Assessment/methods
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U2 - 10.1161/JAHA.123.034493
DO - 10.1161/JAHA.123.034493
M3 - Article
C2 - 38761082
AN - SCOPUS:85194013443
SN - 2047-9980
VL - 13
SP - e034493
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 10
M1 - e034493
ER -