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. 2020 Sep-Oct;14(5):695-706.e4.
doi: 10.1016/j.jacl.2020.06.010. Epub 2020 Jul 3.

Lipoprotein(a) levels and association with myocardial infarction and stroke in a nationally representative cross-sectional US cohort

Eric J Brandt  1 , Arya Mani  2 , Erica S Spatz  3 , Nihar R Desai  3 , Khurram Nasir  4
Affiliations

Lipoprotein(a) levels and association with myocardial infarction and stroke in a nationally representative cross-sectional US cohort

Eric J Brandt et al. J Clin Lipidol. 2020 Sep-Oct.

Abstract

Background: Lipoprotein(a) (Lp(a)) has not been well-studied in a nationally representative US cohort.

Objective: The objective of this study was to investigate the distribution of Lp(a) and its associations with nonfatal cardiovascular events in a nationally representative cohort.

Methods: Cross-sectional analysis using the National Health and Nutrition Examination Survey III cohort (1991-1994). We compared Lp(a) levels across demographics and tested the associations between Lp(a) and patient-reported nonfatal myocardial infarction (MI) and/or stroke using multivariate logistic regression.

Results: Median Lp(a) was 14 mg/dL (interquartile range [IQR]: 3, 32) (n = 8214). 14.7% (95% CI: 13.6%-15.9%) had Lp(a) ≥50 mg/dL. Women had slightly higher median Lp(a) than men (14 mg/dL [IQR: 4, 33] vs 13 [(IQR: 3, 30], P = .001). Non-Hispanics blacks had the highest median Lp(a) (35 mg/dL [IQR: 21, 64]), followed by non-Hispanic whites (12 mg/dL [IQR: 3, 29]) and Mexican Americans (8 mg/dL [IQR:1, 21]). In multivariate analysis, Lp(a) was associated (odds ratio per SD increase [95% CI], P-value) with MI (1.41 [1.14-1.75], P = .001), but not stroke (1.14 [0.91-1.44], P = .26). Lp(a) associated with MI in men (1.52 [1.13-2.04], P = .006), non-Hispanic whites (1.60 [1.27-2.03], P < .001), and Mexican Americans (2.14 [1.29-3.55], P = .003), but not women or non-Hispanic blacks. Lp(a) was not associated with stroke among any subgroups.

Conclusion: In a nationally representative US cohort, 1 in 7 had Lp(a) ≥50 mg/dL, the guidelines-recommended threshold to consider Lp(a) a risk enhancing factor. Lp(a) was associated with nonfatal MI but not stroke, although there were differential associations by sex and race/ethnicity. Future nationally representative cohorts should test Lp(a) to get an updated estimation.

Keywords: Cardiovascular disease; Epidemiology; Lipoprotein (a); Myocardial infarction; Risk; Stroke.

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Conflict of interest statement

Conflicts of interest: Dr Desai reported receiving grants and personal fees from Amgen, Boehringer Ingelheim, and Relypsa; receiving personal fees from Cytokinetics, Novartis, and scPharmaceuticals; having a contract with the Centers for Medicare & Medicaid Services; and receiving funding from Johnson and Johnson and Medtronic outside the submitted work. Dr. Spatz receives support from the Centers for Medicare & Medicaid Services to develop performance measures used in public reporting programs, the Food and Drug Administration to support projects within the Yale-Mayo Clinic Center of Excellence in Regulatory Science and Innovation (CERSI), the National Institute on Minority Health and Health Disparities (U54MD010711–01) to study precision-based approaches to hypertension, and from the National Institute of Biomedical Imaging and Bioengineering (R01 EB028106–01) to study a cuff-less blood pressure device. Dr. Mani receives is supported by grants from the National Institutes of Health (NIH) (RHL135767A). The remaining authors have nothing to disclose.

Figures

Figure 1
Figure 1
Distribution of lipoprotein(a) in the sample population overall and by sex and race/ethnicity.
Figure 2
Figure 2
Odds ratio for MI or stroke at various Lp(a) values in fully adjusted multivariate models. Lp(a), lipoprotein(a); MI, myocardial infarction. *Sample size was 3234 when limiting to population with age over 50 years.
Figure 3
Figure 3
Odds ratio for MI or stroke at various Lp(a) values by sex and race/ethnicity in fully adjusted multivariate models. *Note: max Lp(a) among Other was 123 mg/dL, thus predicted odds ratios above this range were not calculated. Lp(a), lipoprotein(a); MI, myocardial infarction.
Figure 3
Figure 3
Odds ratio for MI or stroke at various Lp(a) values by sex and race/ethnicity in fully adjusted multivariate models. *Note: max Lp(a) among Other was 123 mg/dL, thus predicted odds ratios above this range were not calculated. Lp(a), lipoprotein(a); MI, myocardial infarction.
Figure 3
Figure 3
Odds ratio for MI or stroke at various Lp(a) values by sex and race/ethnicity in fully adjusted multivariate models. *Note: max Lp(a) among Other was 123 mg/dL, thus predicted odds ratios above this range were not calculated. Lp(a), lipoprotein(a); MI, myocardial infarction.
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