The association of lipoprotein(a) with incident heart failure hospitalization

Atherosclerosis Risk in Communities study

Anandita Agarwala, Yashashwi Pokharel, Anum Saeed, Wensheng Sun, Salim S. Virani, Vijay Nambi, Chiadi Ericson Ndumele, Eyal Shahar, Gerardo Heiss, Eric Boerwinkle, Suma Konety, Ron C. Hoogeveen, Christie M. Ballantyne

Research output: Contribution to journalArticle

Abstract

Background and aims Lipoprotein(a) [Lp(a)] is a proatherogenic lipoprotein associated with coronary heart disease, ischemic stroke, and more recently aortic stenosis and heart failure (HF). We examined the association of Lp(a) levels with incident HF hospitalization in the Atherosclerosis Risk in Communities (ARIC) study. We also assessed the relationship between Lp(a) levels and arterial stiffness as a potential mechanism for development of HF. Methods Lp(a) was measured in 14,154 ARIC participants without prevalent HF at ARIC visit 1 (1987–1989). The association of Lp(a) quintiles with incident HF hospitalization was assessed using Cox proportional-hazards models. Arterial stiffness parameters were stratified based on Lp(a) quintiles, and p-trend was calculated across ordered groups. Results At a median follow-up of 23.4 years, there were 2605 incident HF hospitalizations. Lp(a) levels were directly associated with incident HF hospitalization in models adjusted for age, race, gender, systolic blood pressure, history of hypertension, diabetes, smoking status, body mass index, heart rate, and high-density lipoprotein cholesterol (quintile 5 vs. quintile 1: hazard ratio [HR] 1.24, 95% confidence interval [CI] 1.09–1.41; p-trend across increasing quintiles <0.01), but not after excluding prevalent and incident myocardial infarction cases (HR 1.07, 95% CI 0.91–1.27; p-trend = 0.70). When adjusted for age, gender, and race, Lp(a) quintiles were not significantly associated with arterial stiffness parameters. Conclusions Increased Lp(a) levels were associated with increased risk of incident HF hospitalization. After excluding prevalent and incident myocardial infarction, the association was no longer significant. Lp(a) levels were not associated with arterial stiffness parameters.

Original languageEnglish (US)
Pages (from-to)131-137
Number of pages7
JournalAtherosclerosis
Volume262
DOIs
StatePublished - Jul 1 2017

Fingerprint

Lipoprotein(a)
Atherosclerosis
Hospitalization
Heart Failure
Vascular Stiffness
Myocardial Infarction
Confidence Intervals
Blood Pressure
Aortic Valve Stenosis
Proportional Hazards Models
HDL Cholesterol
Lipoproteins
Coronary Disease
Body Mass Index
Heart Rate
Smoking
Stroke
Hypertension

Keywords

  • Heart failure
  • Lipoproteins
  • Risk factors
  • Risk prediction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

The association of lipoprotein(a) with incident heart failure hospitalization : Atherosclerosis Risk in Communities study. / Agarwala, Anandita; Pokharel, Yashashwi; Saeed, Anum; Sun, Wensheng; Virani, Salim S.; Nambi, Vijay; Ndumele, Chiadi Ericson; Shahar, Eyal; Heiss, Gerardo; Boerwinkle, Eric; Konety, Suma; Hoogeveen, Ron C.; Ballantyne, Christie M.

In: Atherosclerosis, Vol. 262, 01.07.2017, p. 131-137.

Research output: Contribution to journalArticle

Agarwala, A, Pokharel, Y, Saeed, A, Sun, W, Virani, SS, Nambi, V, Ndumele, CE, Shahar, E, Heiss, G, Boerwinkle, E, Konety, S, Hoogeveen, RC & Ballantyne, CM 2017, 'The association of lipoprotein(a) with incident heart failure hospitalization: Atherosclerosis Risk in Communities study', Atherosclerosis, vol. 262, pp. 131-137. https://doi.org/10.1016/j.atherosclerosis.2017.05.014
Agarwala, Anandita ; Pokharel, Yashashwi ; Saeed, Anum ; Sun, Wensheng ; Virani, Salim S. ; Nambi, Vijay ; Ndumele, Chiadi Ericson ; Shahar, Eyal ; Heiss, Gerardo ; Boerwinkle, Eric ; Konety, Suma ; Hoogeveen, Ron C. ; Ballantyne, Christie M. / The association of lipoprotein(a) with incident heart failure hospitalization : Atherosclerosis Risk in Communities study. In: Atherosclerosis. 2017 ; Vol. 262. pp. 131-137.
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abstract = "Background and aims Lipoprotein(a) [Lp(a)] is a proatherogenic lipoprotein associated with coronary heart disease, ischemic stroke, and more recently aortic stenosis and heart failure (HF). We examined the association of Lp(a) levels with incident HF hospitalization in the Atherosclerosis Risk in Communities (ARIC) study. We also assessed the relationship between Lp(a) levels and arterial stiffness as a potential mechanism for development of HF. Methods Lp(a) was measured in 14,154 ARIC participants without prevalent HF at ARIC visit 1 (1987–1989). The association of Lp(a) quintiles with incident HF hospitalization was assessed using Cox proportional-hazards models. Arterial stiffness parameters were stratified based on Lp(a) quintiles, and p-trend was calculated across ordered groups. Results At a median follow-up of 23.4 years, there were 2605 incident HF hospitalizations. Lp(a) levels were directly associated with incident HF hospitalization in models adjusted for age, race, gender, systolic blood pressure, history of hypertension, diabetes, smoking status, body mass index, heart rate, and high-density lipoprotein cholesterol (quintile 5 vs. quintile 1: hazard ratio [HR] 1.24, 95{\%} confidence interval [CI] 1.09–1.41; p-trend across increasing quintiles <0.01), but not after excluding prevalent and incident myocardial infarction cases (HR 1.07, 95{\%} CI 0.91–1.27; p-trend = 0.70). When adjusted for age, gender, and race, Lp(a) quintiles were not significantly associated with arterial stiffness parameters. Conclusions Increased Lp(a) levels were associated with increased risk of incident HF hospitalization. After excluding prevalent and incident myocardial infarction, the association was no longer significant. Lp(a) levels were not associated with arterial stiffness parameters.",
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AU - Agarwala, Anandita

AU - Pokharel, Yashashwi

AU - Saeed, Anum

AU - Sun, Wensheng

AU - Virani, Salim S.

AU - Nambi, Vijay

AU - Ndumele, Chiadi Ericson

AU - Shahar, Eyal

AU - Heiss, Gerardo

AU - Boerwinkle, Eric

AU - Konety, Suma

AU - Hoogeveen, Ron C.

AU - Ballantyne, Christie M.

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N2 - Background and aims Lipoprotein(a) [Lp(a)] is a proatherogenic lipoprotein associated with coronary heart disease, ischemic stroke, and more recently aortic stenosis and heart failure (HF). We examined the association of Lp(a) levels with incident HF hospitalization in the Atherosclerosis Risk in Communities (ARIC) study. We also assessed the relationship between Lp(a) levels and arterial stiffness as a potential mechanism for development of HF. Methods Lp(a) was measured in 14,154 ARIC participants without prevalent HF at ARIC visit 1 (1987–1989). The association of Lp(a) quintiles with incident HF hospitalization was assessed using Cox proportional-hazards models. Arterial stiffness parameters were stratified based on Lp(a) quintiles, and p-trend was calculated across ordered groups. Results At a median follow-up of 23.4 years, there were 2605 incident HF hospitalizations. Lp(a) levels were directly associated with incident HF hospitalization in models adjusted for age, race, gender, systolic blood pressure, history of hypertension, diabetes, smoking status, body mass index, heart rate, and high-density lipoprotein cholesterol (quintile 5 vs. quintile 1: hazard ratio [HR] 1.24, 95% confidence interval [CI] 1.09–1.41; p-trend across increasing quintiles <0.01), but not after excluding prevalent and incident myocardial infarction cases (HR 1.07, 95% CI 0.91–1.27; p-trend = 0.70). When adjusted for age, gender, and race, Lp(a) quintiles were not significantly associated with arterial stiffness parameters. Conclusions Increased Lp(a) levels were associated with increased risk of incident HF hospitalization. After excluding prevalent and incident myocardial infarction, the association was no longer significant. Lp(a) levels were not associated with arterial stiffness parameters.

AB - Background and aims Lipoprotein(a) [Lp(a)] is a proatherogenic lipoprotein associated with coronary heart disease, ischemic stroke, and more recently aortic stenosis and heart failure (HF). We examined the association of Lp(a) levels with incident HF hospitalization in the Atherosclerosis Risk in Communities (ARIC) study. We also assessed the relationship between Lp(a) levels and arterial stiffness as a potential mechanism for development of HF. Methods Lp(a) was measured in 14,154 ARIC participants without prevalent HF at ARIC visit 1 (1987–1989). The association of Lp(a) quintiles with incident HF hospitalization was assessed using Cox proportional-hazards models. Arterial stiffness parameters were stratified based on Lp(a) quintiles, and p-trend was calculated across ordered groups. Results At a median follow-up of 23.4 years, there were 2605 incident HF hospitalizations. Lp(a) levels were directly associated with incident HF hospitalization in models adjusted for age, race, gender, systolic blood pressure, history of hypertension, diabetes, smoking status, body mass index, heart rate, and high-density lipoprotein cholesterol (quintile 5 vs. quintile 1: hazard ratio [HR] 1.24, 95% confidence interval [CI] 1.09–1.41; p-trend across increasing quintiles <0.01), but not after excluding prevalent and incident myocardial infarction cases (HR 1.07, 95% CI 0.91–1.27; p-trend = 0.70). When adjusted for age, gender, and race, Lp(a) quintiles were not significantly associated with arterial stiffness parameters. Conclusions Increased Lp(a) levels were associated with increased risk of incident HF hospitalization. After excluding prevalent and incident myocardial infarction, the association was no longer significant. Lp(a) levels were not associated with arterial stiffness parameters.

KW - Heart failure

KW - Lipoproteins

KW - Risk factors

KW - Risk prediction

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