Lipoprotein(a) and Increased Cardiovascular Risk in Women

• Type of Material: Article
• Authors: Brian T. Costello, Rush University; Eric R. Silverman, Rush University; Rami Doukky, Rush University; Lynne T. Braun, Rush University; Neelum T. Aggarwal, Rush University; Youping Deng, Rush University; Yan Li, Emory University; Gina Lundberg, Emory University; Kim A. Williams, Rush University; Anabelle S. Volgman, Rush University
• Language: English
• Date: 2016-02-01
• Publisher: Wiley Open Access: Various Creative Commons Licenses
• Publication Version: Final Published Version
• Copyright Statement: © 2016 Wiley Periodicals, Inc.
• Final Published Version (URL): http://dx.doi.org/10.1002/clc.22500
• Title of Journal or Parent Work: Clinical Cardiology
• ISSN: 0160-9289
• Volume: 39
• Issue: 2
• Start Page: 96
• End Page: 102
• Keywords: Science & Technology; Cardiovascular System & Cardiology; THERAPY; MARKERS; Cardiac & Cardiovascular Systems; METAANALYSIS; ELEVATED LIPOPROTEIN(A); PLASMA LIPOPROTEIN(A); LP(A); ARTERY-DISEASE; APOLIPOPROTEIN(A) GENE; CORONARY-HEART-DISEASE; Life Sciences & Biomedicine; PREDICTION
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Background: Approximately 20% of the population has elevated circulating levels of lipoprotein(a) (Lp[a]), one of the most robust predictors of cardiovascular disease risk. This is particularly true for women. Hypothesis: Many female patients with "normal" traditional risk factors or low atherosclerotic cardiovascular disease (ASCVD) risk scores may harbor high risk related to elevated levels of Lp(a). Methods: A retrospective, cross-sectional study of consecutive female patients presenting to Heart Centers for Women was performed. Discordance between low-density lipoprotein cholesterol (LDL-C) and Lp(a) was determined. The ASCVD risk and Reynolds Risk Score models A (RRS-A) and B (RRS-B) were calculated, and level of agreement in patients meeting treatment threshold (≥7.5% for ASCVD, ≥10% for RRS-A and RRS-B) were compared. Results: Among 713 women, 290 (41%) had elevated Lp(a); however, LDL-C and Lp(a) were weakly correlated (r = 0.08). Significant discordance was observed between abnormal LDL-C and Lp(a) levels (McNemar P = 0.03). There was moderate correlation between RRS-A and ASCVD risk (r = 0.71, P < 0.001), and Bland-Altman plot showed diminished correlation with increased risk. More patients met treatment threshold by ASCVD risk estimation, but nearly 1 out of 20 patients met treatment threshold by RRS-A but not ASCVD score. Conclusions: There is high prevalence of elevated Lp(a) among women presenting to Heart Centers for Women. Although traditional risk markers such as elevated LDL-C or high ASCVD risk may be absent in some women, elevated Lp(a) may identify patients who may benefit from aggressive risk-factor modification and pharmacologic therapy.