Lipoprotein(a) and Increased Cardiovascular Risk in Women

• 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
• Journal Title: Clinical Cardiology
• Volume: Volume 39, Number 2
• Publisher: Wiley Open Access: Various Creative Commons Licenses | 2016-02-01, Pages 96-102
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1002/clc.22500
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; CORONARY-HEART-DISEASE; ARTERY-DISEASE; ELEVATED LIPOPROTEIN(A); APOLIPOPROTEIN(A) GENE; PLASMA LIPOPROTEIN(A); PREDICTION; THERAPY; METAANALYSIS; MARKERS; LP(A)

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.