Lipoprotein (a) and the Occurrence of Lipid Disorders and Other Cardiovascular Risk Factors in Patients without Diagnosed Cardiovascular Disease
Abstract
:1. Introduction
2. Materials and Methods
Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Szymański, F.M.; Mickiewicz, A.; Dzida, G.; Gorczyca-Głowacka, I.; Kozłowski, D.; Widecka, K.; Krasiński, Z.; Kobayashi, A.; Hering, D.; Mizia-Stec, K.; et al. Management of Dyslipidemia in Poland: Interdisciplinary Expert Position Statement Endorsed by the Polish Cardiac Society Working Group on Cardiovascular Pharmacotherapy. The Fourth Declaration of Sopot. Cardiol. J. 2022, 29, 1–26. [Google Scholar] [CrossRef] [PubMed]
- Roth, G.A.; Mensah, G.A.; Johnson, C.O.; Addolorato, G.; Ammirati, E.; Baddour, L.M.; Barengo, N.C.; Beaton, A.Z.; Benjamin, E.J.; Benziger, C.P.; et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019. J. Am. Coll. Cardiol. 2020, 76, 2982–3021. [Google Scholar] [CrossRef] [PubMed]
- Kotseva, K.; De Backer, G.; De Bacquer, D.; Rydén, L.; Hoes, A.; Grobbee, D.; Maggioni, A.; Marques-Vidal, P.; Jennings, C.; Abreu, A.; et al. Primary Prevention Efforts Are Poorly Developed in People at High Cardiovascular Risk: A Report from the European Society of Cardiology EURObservational Research Programme EUROASPIRE V Survey in 16 European Countries. Eur. J. Prev. Cardiol. 2021, 28, 370–379. [Google Scholar] [CrossRef]
- Ratajczak, J.; Kubica, A.; Michalski, P.; Pietrzykowski, Ł.; Białczyk, A.; Kosobucka-Ozdoba, A.; Bergmann, K.; Buczkowski, K.; Krintus, M.; Jankowski, P.; et al. Determinants of Lipid Parameters in Patients without Diagnosed Cardiovascular Disease—Results of the Polish Arm of the EUROASPIRE V Survey. J. Clin. Med. 2023, 12, 2738. [Google Scholar] [CrossRef] [PubMed]
- Kubica, A.; Pietrzykowski, Ł.; Michalski, P.; Kasprzak, M.; Ratajczak, J.; Siódmiak, J.; Fabiszak, T.; Buczkowski, K.; Krintus, M.; Jankowski, P. The Occurrence of Cardiovascular Risk Factors and Functioning in Chronic Illness in the Polish Population of EUROASPIRE V. Cardiol. J. 2022; ahead of print. [Google Scholar] [CrossRef]
- Nowowiejska-Wiewióra, A.; Wita, K.; Mędrala, Z.; Tomkiewicz-Pająk, L.; Bujak, K.; Mizia-Stec, K.; Brzychczy, P.; Gąsior, M.; Gąsior, Z.; Kulbat, A.; et al. Dyslipidemia Treatment and Attainment of LDL-Cholesterol Treatment Goals in Patients Participating in the Managed Care for Acute Myocardial Infarction Survivors Program. Kardiol. Pol. 2023, 81, 359–365. [Google Scholar] [CrossRef]
- Mach, F.; Baigent, C.; Catapano, A.L.; Koskinas, K.C.; Casula, M.; Badimon, L.; Chapman, M.J.; De Backer, G.G.; Delgado, V.; Ference, B.A.; et al. 2019 ESC/EAS Guidelines for the Management of Dyslipidaemias: Lipid Modification to Reduce Cardiovascular Risk. Eur. Heart J. 2020, 41, 111–188. [Google Scholar] [CrossRef]
- Armitage, J.; Baigent, C.; Barnes, E.; Betteridge, D.J.; Blackwell, L.; Blazing, M.; Bowman, L.; Braunwald, E.; Byington, R.; Cannon, C.; et al. Efficacy and Safety of Statin Therapy in Older People: A Meta-Analysis of Individual Participant Data from 28 Randomised Controlled Trials. Lancet 2019, 393, 407–415. [Google Scholar] [CrossRef]
- Carr, S.S.; Hooper, A.J.; Sullivan, D.R.; Burnett, J.R. Non-HDL-Cholesterol and Apolipoprotein B Compared with LDL-Cholesterol in Atherosclerotic Cardiovascular Disease Risk Assessment. Pathology 2019, 51, 148–154. [Google Scholar] [CrossRef]
- Visseren, F.L.J.; Mach, F.; Smulders, Y.M.; Carballo, D.; Koskinas, K.C.; Bäck, M.; Benetos, A.; Biffi, A.; Boavida, J.-M.; Capodanno, D.; et al. 2021 ESC Guidelines on Cardiovascular Disease Prevention in Clinical Practice. Eur. Heart J. 2021, 42, 3227–3337. [Google Scholar] [CrossRef]
- Mitkowski, P.; Witkowski, A.; Stępińska, J.; Banach, M.; Jankowski, P.; Gąsior, M.; Wita, K.; Bartuś, S.; Burchardt, P.; Farkowski, M.M.; et al. Position of the Polish Cardiac Society on Therapeutic Targets for LDL Cholesterol Concentrations in Secondary Prevention of Myocardial Infarctions. Kardiol. Pol. 2023, 81, 818–823. [Google Scholar] [CrossRef] [PubMed]
- Burgess, S.; Ference, B.A.; Staley, J.R.; Freitag, D.F.; Mason, A.M.; Nielsen, S.F.; Willeit, P.; Young, R.; Surendran, P.; Karthikeyan, S.; et al. Association of LPA Variants with Risk of Coronary Disease and the Implications for Lipoprotein(a)-Lowering Therapies: A Mendelian Randomization Analysis. JAMA Cardiol. 2018, 3, 619–627. [Google Scholar] [CrossRef] [PubMed]
- Sosnowska, B.; Stepinska, J.; Mitkowski, P.; Bielecka-Dabrowa, A.; Bobrowska, B.; Budzianowski, J.; Burchardt, P.; Chlebus, K.; Dobrowolski, P.; Gasior, M.; et al. Recommendations of the Experts of the Polish Cardiac Society (PCS) and the Polish Lipid Association (PoLA) on the Diagnosis and Management of Elevated Lipoprotein(a) Levels. Arch. Med. Sci. 2024, 20, 8–27. [Google Scholar] [CrossRef] [PubMed]
- Patel, A.P.; Wang, M.; Pirruccello, J.P.; Ellinor, P.T.; Ng, K.; Kathiresan, S.; Khera, A.V. Lp(a) (Lipoprotein[a]) Concentrations and Incident Atherosclerotic Cardiovascular Disease: New Insights From a Large National Biobank. Arterioscler. Thromb. Vasc. Biol. 2021, 41, 465–474. [Google Scholar] [CrossRef] [PubMed]
- Kamstrup, P.R. Lipoprotein(a) and Cardiovascular Disease. Clin. Chem. 2021, 67, 154–166. [Google Scholar] [CrossRef] [PubMed]
- Banach, M.; Burchardt, P.; Chlebus, K.; Dobrowolski, P.; Dudek, D.; Dyrbuś, K.; Gąsior, M.; Jankowski, P.; Jóźwiak, J.; Kłosiewicz-Latoszek, L.; et al. PoLA/CFPiP/PCS/PSLD/PSD/PSH Guidelines on Diagnosis and Therapy of Lipid Disorders in Poland 2021. Arch. Med. Sci. 2021, 17, 1447–1547. [Google Scholar] [CrossRef] [PubMed]
- Reyes-Soffer, G.; Ginsberg, H.N.; Berglund, L.; Duell, P.B.; Heffron, S.P.; Kamstrup, P.R.; Lloyd-Jones, D.M.; Marcovina, S.M.; Yeang, C.; Koschinsky, M.L.; et al. Lipoprotein(a): A Genetically Determined, Causal, and Prevalent Risk Factor for Atherosclerotic Cardiovascular Disease: A Scientific Statement from the American Heart Association. Arterioscler. Thromb. Vasc. Biol. 2022, 42, e48–e60. [Google Scholar] [CrossRef] [PubMed]
- Konieczyńska, M.; Nowak, K.; Pudło, J.; Zasada, M.; Tlałka, M.; Wypasek, E.; Zalewski, J.; Polak, M.; Undas, A. Elevated Lipoprotein(a) in the Middle-Aged Polish Population: Preliminary Data on the Genetic Background. Kardiol. Pol. 2023, 81, 1279–1281. [Google Scholar] [CrossRef] [PubMed]
- Varvel, S.; McConnell, J.P.; Tsimikas, S. Prevalence of Elevated Lp(a) Mass Levels and Patient Thresholds in 532 359 Patients in the United States. Arterioscler. Thromb. Vasc. Biol. 2016, 36, 2239–2245. [Google Scholar] [CrossRef] [PubMed]
- Stătescu, C.; Anghel, L.; Benchea, L.-C.; Tudurachi, B.-S.; Leonte, A.; Zăvoi, A.; Zota, I.M.; Prisacariu, C.; Radu, R.; Șerban, I.-L.; et al. A Systematic Review on the Risk Modulators of Myocardial Infarction in the “Young”—Implications of Lipoprotein (a). Int. J. Mol. Sci. 2023, 24, 5927. [Google Scholar] [CrossRef] [PubMed]
- Raitakari, O.; Kivelä, A.; Pahkala, K.; Rovio, S.; Mykkänen, J.; Ahola-Olli, A.; Loo, B.-M.; Lyytikäinen, L.-P.; Lehtimäki, T.; Kähönen, M.; et al. Long-Term Tracking and Population Characteristics of Lipoprotein (a) in the Cardiovascular Risk in Young Finns Study. Atherosclerosis 2022, 356, 18–27. [Google Scholar] [CrossRef]
- Heller, F.R.; Jamart, J.; Honore, P.; Derue, G.; Novik, V.; Galanti, L.; Parfonry, A.; Hondekijn, J.C.; Buysschaert, M. Serum Lipoprotein(a) in Patients with Diabetes Mellitus. Diabetes Care 1993, 16, 819–823. [Google Scholar] [CrossRef] [PubMed]
- Labudovic, D.D.; Toseska, K.N.; Alabakovska, S.B.; Todorova, B. Apoprotein(a) Phenotypes and Plasma Lipoprotein(a) Concentration in Patients with Diabetes Mellitus. Clin. Biochem. 2003, 36, 545–551. [Google Scholar] [CrossRef] [PubMed]
- Lamina, C.; Ward, N.C. Lipoprotein (a) and Diabetes Mellitus. Atherosclerosis 2022, 349, 63–71. [Google Scholar] [CrossRef] [PubMed]
- Kaltoft, M.; Langsted, A.; Afzal, S.; Kamstrup, P.R.; Nordestgaard, B.G. Lipoprotein(a) and Body Mass Compound the Risk of Calcific Aortic Valve Disease. J. Am. Coll. Cardiol. 2022, 79, 545–558. [Google Scholar] [CrossRef] [PubMed]
- Cai, D.-P.; He, Y.-M.; Yang, X.-J.; Zhao, X.; Xu, H.-F. Lipoprotein (a) Is a Risk Factor for Coronary Artery Disease in Chinese Han Ethnic Population Modified by Some Traditional Risk Factors: A Cross-Sectional Study of 3462 Cases and 6125 Controls. Clin. Chim. Acta 2015, 451, 278–286. [Google Scholar] [CrossRef] [PubMed]
- Boerwinkle, E.; Leffert, C.C.; Lin, J.; Lackner, C.; Chiesa, G.; Hobbs, H.H. Apolipoprotein(a) Gene Accounts for Greater than 90% of the Variation in Plasma Lipoprotein(a) Concentrations. J. Clin. Investig. 1992, 90, 52–60. [Google Scholar] [CrossRef] [PubMed]
- Enkhmaa, B.; Berglund, L. Non-Genetic Influences on Lipoprotein(a) Concentrations. Atherosclerosis 2022, 349, 53–62. [Google Scholar] [CrossRef] [PubMed]
- van Buuren, F.; Horstkotte, D.; Knabbe, C.; Hinse, D.; Mellwig, K.P. Incidence of Elevated Lipoprotein(a) Levels in a Large Cohort of Patients with Cardiovascular Disease. Clin. Res. Cardiol. Suppl. 2017, 12, 55–59. [Google Scholar] [CrossRef] [PubMed]
- Nissen, S.E.; Wolski, K.; Cho, L.; Nicholls, S.J.; Kastelein, J.; Leitersdorf, E.; Landmesser, U.; Blaha, M.; Lincoff, A.M.; Morishita, R.; et al. Lipoprotein(a) Levels in a Global Population with Established Atherosclerotic Cardiovascular Disease. Open Heart 2022, 9, e002060. [Google Scholar] [CrossRef]
- Oo, H.P.; Giovannucci, J.; O’Brien, R.C.; Hare, D.L. The Prevalence of Elevated Lipoprotein(a) in Patients Presenting with Coronary Artery Disease. Heart Lung Circ. 2020, 29, 1682–1687. [Google Scholar] [CrossRef]
- Di Fusco, S.A.; Arca, M.; Scicchitano, P.; Alonzo, A.; Perone, F.; Gulizia, M.M.; Gabrielli, D.; Oliva, F.; Imperoli, G.; Colivicchi, F. Lipoprotein(a): A Risk Factor for Atherosclerosis and an Emerging Therapeutic Target. Heart 2022, 109, 18–25. [Google Scholar] [CrossRef] [PubMed]
- Kronenberg, F.; Mora, S.; Stroes, E.S.G.; Ference, B.A.; Arsenault, B.J.; Berglund, L.; Dweck, M.R.; Koschinsky, M.; Lambert, G.; Mach, F.; et al. Lipoprotein(a) in Atherosclerotic Cardiovascular Disease and Aortic Stenosis: A European Atherosclerosis Society Consensus Statement. Eur. Heart J. 2022, 43, 3925–3946. [Google Scholar] [CrossRef] [PubMed]
Analyzed Parameter | Value | |
---|---|---|
Age, median (IQR) | 52.0 (43.0–60.0) | |
Higher education, n (%) | 117 (58.5) | |
Male gender, n (%) | 133 (66.5) | |
Marital status, n (%) | Low | 30 (15.0) |
Average | 141(70.5) | |
High | 29 (14.5) | |
History of hyperlipidemia, n (%) | 105 (52.5) | |
Lipid-lowering drugs, n (%) | 92 (46.0) | |
History of hypertension, n (%) | 140 (70.0) | |
History of DM, n (%) | 41 (20.5) | |
AC [cm], median (IQR) | 87.0 (80.0–95.5) | |
AC, n (%) | Normal | 74 (37.0) |
Overweight [F ≥ 80 cm and <88 cm, M ≥ 94 cm and <102 cm] | 57 (28.5) | |
Obesity [F ≥ 88 cm, M ≥ 102 cm] | 69 (34.5) | |
BMI [kg/m2], median (IQR) | 26.0 (24.0–28.7) | |
BMI category, n (%) | Underweight < 18.5 kg/m2 | 6 (3.0) |
Normal 18.5–24.9 kg/m2 | 77 (38.5) | |
Overweight 25.0–29.9 kg/m2 | 84 (42.0) | |
Obesity > 30.0 kg/m2 | 33 (16.5) | |
Smoker, n (%) | 30 (15.0) | |
Inadequate physical activity, n (%) | 119 (59.5) | |
TC [mmol/L], median (IQR) | 5.56 (4.91–6.26) | |
non-HDL [mmol/L], median (IQR) | 3.99 (3.39–4.68) | |
LDL-C [mmol/L], median (IQR) | 3.29 (2.68–4.0) | |
HDL-C [mmol/L], median (IQR) | 1.50 (1.25–1.81) | |
TG [mmol/L], median (IQR) | 1.21 (0.90–1.55) | |
sdLDL, [mmol/L], median (IQR) | 0.64 (0.53–0.78) | |
Lp(a) [mg/dL], median (IQR) | 9.19 (3.54–42.07) | |
Lp(a) category, n (%) | Lp(a) < 30 mg/dL | 140 (70.0) |
Lp(a) ≥ 30 mg/dL | 60 (30.0) | |
FPG [mmol/L], median (IQR) | 5.42 (5.04–5.88) | |
hsTnI [ng/L], median (IQR) | 2.3 (1.6–3.2) | |
CRP [mg/L], median (IQR) | 0.9 (0.6–1.7) | |
Serum creatinine [mg/dL], median (IQR) | 0.8 (0.7–0.9) |
CV Risk Factor | Total Studied Group, n (%) | Lp(a) <30 mg/dL, n (%) | Lp(a) ≥30 mg/dL, n (%) | p-Value |
---|---|---|---|---|
Age ≥ 60 years | 55 (27.5) | 46 (32.9) | 9 (15.0) | 0.01 |
History of hyperlipidemia | 105 (52.5) | 66 (47.1) | 39 (65.0) | 0.02 |
History of hypertension | 140 (70.0) | 101 (72.1) | 39 (65.0) | 0.312 |
History of DM | 41 (20.5) | 24 (17.1) | 17 (28.3) | 0.072 |
AC overweight and obesity | 126 (63.0) | 94 (67.1) | 32 (53.3) | 0.064 |
BMI overweight and obesity | 117 (58.5) | 89 (63.6) | 28 (46.7) | 0.026 |
Smoker | 30 (15.0) | 21 (15.0) | 9 (15.0) | 0.999 |
Inadequate physical activity | 119 (59.5) | 85 (60.7) | 34 (56.7) | 0.593 |
TC > 4.9 mmol/L (>190 mg/dL) | 152 (76.0) | 108 (77.1) | 44 (73.3) | 0.563 |
Non-HDL-C > 3.4 mmol/L (>130 mg/dL) | 148 (74.0) | 102 (72.9) | 46 (76.7) | 0.574 |
LDL-C > 3.0 mmol/L (>115 mg/dL) | 122 (61.0) | 83 (59.3) | 39 (65.0) | 0.448 |
HDL-C—M < 1.0 mmol/L (<40 mg/dL), F < 1.2 mmol/L (<45 mg/dL) | 24 (12.0) | 16 (11.4) | 8 (13.3) | 0.704 |
TG > 1.7 mmol/L (>150 mg/dL) | 37 (18.5) | 29 (20.7) | 8 (13.3) | 0.218 |
sdLDL > 1.0 mmol/L (>40 mg/dL) | 15 (7.5) | 14 (10.0) | 1 (1.7) | 0.04 |
Lipid Parameters | Lp(a) <30 mg/dL | Lp(a) ≥30 mg/dL | p-Value |
---|---|---|---|
TC [mmol/L], median (IQR) | 5.56 (4.98–6.41) | 5.55 (4.82–6.20) | 0.537 |
non-HDL-C [mmol/L], median (IQR) | 4.01 (3.35–4.76) | 3.95 (3.43–4.57) | 0.539 |
LDL-C [mmol/L], median (IQR) | 3.29 (2.66–4.02) | 3.24 (2.76–3.83) | 0.904 |
HDL-C [mmol/L], median (IQR) | 1.5 (1.24–1.83) | 1.51 (1.26–1.77) | 0.995 |
TG [mmol/L], median (IQR) | 1.28 (0.92–1.59) | 1.11 (0.87–1.40) | 0.109 |
sdLDL, [mmol/L], median (IQR) | 0.65 (0.53–0.81) | 0.60 (0.52–0.72) | 0.126 |
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Ratajczak, J.; Kubica, A.; Pietrzykowski, Ł.; Michalski, P.; Kosobucka-Ozdoba, A.; Buczkowski, K.; Krintus, M.; Jankowski, P.; Kubica, J. Lipoprotein (a) and the Occurrence of Lipid Disorders and Other Cardiovascular Risk Factors in Patients without Diagnosed Cardiovascular Disease. J. Clin. Med. 2024, 13, 4649. https://doi.org/10.3390/jcm13164649
Ratajczak J, Kubica A, Pietrzykowski Ł, Michalski P, Kosobucka-Ozdoba A, Buczkowski K, Krintus M, Jankowski P, Kubica J. Lipoprotein (a) and the Occurrence of Lipid Disorders and Other Cardiovascular Risk Factors in Patients without Diagnosed Cardiovascular Disease. Journal of Clinical Medicine. 2024; 13(16):4649. https://doi.org/10.3390/jcm13164649
Chicago/Turabian StyleRatajczak, Jakub, Aldona Kubica, Łukasz Pietrzykowski, Piotr Michalski, Agata Kosobucka-Ozdoba, Krzysztof Buczkowski, Magdalena Krintus, Piotr Jankowski, and Jacek Kubica. 2024. "Lipoprotein (a) and the Occurrence of Lipid Disorders and Other Cardiovascular Risk Factors in Patients without Diagnosed Cardiovascular Disease" Journal of Clinical Medicine 13, no. 16: 4649. https://doi.org/10.3390/jcm13164649