Association of Lipoprotein(a)-Associated Mortality and the Estimated Glomerular Filtration Rate Level in Patients Undergoing Coronary Angiography: A 51,500 Cohort Study

Abstract

Background: High lipoprotein(a) is associated with poor prognosis in patients at high risk for cardiovascular disease. Renal function based on the estimated glomerular filtration rate (eGFR) is a potential risk factor for the change of lipoprotein(a). However, the regulatory effect of eGFR stratification on lipoprotein(a)-associated mortality has not been adequately addressed. Methods: 51,500 patients who underwent coronary angiography (CAG) or percutaneous coronary intervention (PCI) were included from the Cardiorenal ImprovemeNt (CIN) study (ClinicalTrials.gov NCT04407936). These patients were grouped according to lipoprotein(a) quartiles (Q1-Q4) stratified by eGFR categories (<60 and ≥60 mL/min/1.73m2). Cox regression models were used to estimate hazard ratios (HR) for mortality across combined eGFR and lipoprotein(a) categories. Results: The mean age of the study population was 62.3 ± 10.6 years, 31.3% were female (n = 16,112). During a median follow-up of 5.0 years (interquartile range: 3.0-7.6 years), 13.0% (n = 6,695) of patients died. Compared with lipoprotein(a) Q1, lipoprotein(a) Q2-Q4 was associated with 10% increased adjusted risk of death in all patients (HR: 1.10 [95% CI: 1.03-1.17]), and was strongly associated with about 23% increased adjusted risk of death in patients with eGFR <60 mL/min/1.73m2 (HR: 1.23 [95% CI: 1.08-1.39]), while such association was not significant in patients with eGFR ≥60 mL/min/1.73m2 (HR: 1.05 [95% CI: 0.97-1.13]). P for interaction between lipoprotein(a) (Q1 vs. Q2-Q4) and eGFR (≥60 vs. eGFR <60 mL/min/1.73m2) on all-cause mortality was 0.019. Conclusions: Elevated lipoprotein(a) was associated with increased risk of all-cause mortality and such an association was modified by the baseline eGFR in CAG patients. More attention should be paid to the patients with reduced eGFR and elevated lipoprotein(a), and the appropriate lipoprotein(a) intervention is required.

Keywords: all-cause mortality; coronary angiography; estimated glomerular filtration rate; lipoprotein(a); renal function.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Huang, Yang, Lu, Liang, He, Yu, Huang, Li, Wang, Li, Yan, Xu, Liu, Chen, Huang, Ni, Liu, Chen and Chen.

Figures

Figure 1

Lipoprotein(a)-associated risk of all-cause mortality in different eGFR levels. model (1) unadjusted; (2) adjusted for demographic characteristics (gender and age); (3) adjusted for demographic characteristics, medical history (percutaneous coronary intervention, acute myocardial infarction, hypertension, diabetes mellitus, anemia, stroke, congestive heart failure, coronary artery disease, valvular heart disease, atrial fibrillation); (4) adjusted for demographic characteristics, medical history, and laboratory tests (low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides); (5) adjusted for demographic characteristics, medical history, laboratory tests, and medications (angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, beta-blockers, statins).

Figure 2

Kaplan-Meier curves for cumulative hazard of all-cause mortality by lipoprotein(a) categories stratified eGFR.