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Multicenter Study
. 2024 May 7;83(18):1743-1755.
doi: 10.1016/j.jacc.2024.03.367.

Association of Lipoprotein(a) Levels With Myocardial Infarction in Patients With Low-Attenuation Plaque

Meng-Meng Yu  1 , Ming-Liang Wang  2 , Jin-Jin Wang  3 , Bo-Li Lin  4 , Xin Zhao  5 , Xin-Wei Tao  6 , Yin-Yin Chen  1 , Peng-Yang Li  7 , Jing-Kun Zhang  8 , Jun-Bo Ge  5 , Hang Jin  9 , Meng-Su Zeng  10
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Free article
Multicenter Study

Association of Lipoprotein(a) Levels With Myocardial Infarction in Patients With Low-Attenuation Plaque

Meng-Meng Yu et al. J Am Coll Cardiol. .
Free article

Abstract

Background: Lipoprotein(a) (Lp[a]) is associated with an increased risk of myocardial infarction (MI). However, the mechanism underlying this association has yet to be fully elucidated.

Objectives: This multicenter study aimed to investigate whether association between Lp(a) and MI risk is reinforced by the presence of low-attenuation plaque (LAP) identified by coronary computed tomography angiography (CCTA).

Methods: In a derivation cohort, a total of 5,607 patients with stable chest pain suspected of coronary artery disease who underwent CCTA and Lp(a) measurement were prospectively enrolled. In validation cohort, 1,122 patients were retrospectively collected during the same period. High Lp(a) was defined as Lp(a) ≥50 mg/dL. The primary endpoint was a composite of time to fatal or nonfatal MI. Associations were estimated using multivariable Cox proportional hazard models.

Results: During a median follow-up of 8.2 years (Q1-Q3: 7.2-9.3 years), the elevated Lp(a) levels were associated with MI risk (adjusted HR [aHR]: 1.91; 95% CI: 1.46-2.49; P < 0.001). There was a significant interaction between Lp(a) and LAP (Pinteraction <0.001) in relation to MI risk. When stratified by the presence or absence of LAP, Lp(a) was associated with MI in patients with LAP (aHR: 3.03; 95% CI: 1.92-4.76; P < 0.001). Mediation analysis revealed that LAP mediated 73.3% (P < 0.001) for the relationship between Lp(a) and MI. The principal findings remained unchanged in the validation cohort.

Conclusions: 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.

Keywords: atherosclerotic plaque; computed tomography angiography; coronary artery disease; lipoprotein(a); myocardial infarction.

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Conflict of interest statement

Funding Support and Author Disclosures This study is supported by the National Natural Science Foundation of China (Grant Nos. 82102033; 82300375), Shanghai Rising Stars of Medical Talent Youth Development Program [Grant No. SHWRS(2023)-062], Shanghai Sailing Program (Grant No. 20YF1435900), Shanghai Pujiang Program (Grant No. 21PJD012), and Science Foundation of Shanghai Municipal Health Commission (Grant No. 202040349). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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