AUTHOR=Liu Jin , Liu Liwei , Wang Bo , Chen Shiqun , Liu Buyun , Liang Jingjing , Huang Haozhang , Li Qiang , Lun Zhubin , Ying Ming , Chen Guanzhong , Huang Zhidong , Xu Danyuan , Yan Xiaoming , Zhu Tingting , Tadesse Girmaw Abebe , Tan Ning , Chen Jiyan , Liu Yong 

TITLE=Coronary Artery Disease: Optimal Lipoprotein(a) for Survival—Lower Is Better? A Large Cohort With 43,647 Patients

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.670859

DOI=10.3389/fcvm.2021.670859

ISSN=2297-055X

ABSTRACT=<p><bold>Background:</bold> A high level of lipoprotein(a) can lead to a high risk of cardiovascular events or mortality. However, the association of moderately elevated lipoprotein(a) levels (≥15 mg/dL) with long-term prognosis among patients with coronary artery disease (CAD) is still uncertain. Hence, we aim to systematically analyzed the relevance of baseline plasma lipoprotein(a) levels to long-term mortality in a large cohort of CAD patients.</p><p><bold>Methods:</bold> We obtained data from 43,647 patients who were diagnosed with CAD and had follow-up information from January 2007 to December 2018. The patients were divided into two groups (&lt;15 and ≥15 mg/dL). The primary endpoint was long-term all-cause death. Kaplan–Meier curve analysis and Cox proportional hazards models were used to investigate the association between moderately elevated baseline lipoprotein(a) levels (≥15 mg/dL) and long-term all-cause mortality.</p><p><bold>Results:</bold> During a median follow-up of 5.04 years, 3,941 (18.1%) patients died. We observed a linear association between lipoprotein(a) levels and long-term all-cause mortality. Compared with lipoprotein(a) concentrations &lt;15 mg/dL, lipoprotein(a) ≥15 mg/dL was associated with a significantly higher risk of all-cause mortality [adjusted hazard ratio (aHR) 1.10, 95%CI: 1.04–1.16, <italic>P</italic>-values = 0.001). Similar results were found for the subgroup analysis of non-acute myocardial infarction, non-percutaneous coronary intervention, chronic heart failure, diabetes mellitus, or non-chronic kidney diseases.</p><p><bold>Conclusion:</bold> Moderately elevated baseline plasma lipoprotein(a) levels (≥15 mg/dL) are significantly associated with higher all-cause mortality in patients with CAD. Our finding provides a rationale for testing the lipoprotein(a)-reducing hypothesis with lower targets (even &lt;15 mg/dL) in CAD outcome trials.</p>