{Reference Type}: Journal Article
{Title}: Impact of Lipoprotein(a) Level on Low-Density Lipoprotein Cholesterol- or Apolipoprotein B-Related Risk of Coronary Heart Disease.
{Author}: Arnold N;Blaum C;Goßling A;Brunner FJ;Bay B;Zeller T;Ferrario MM;Brambilla P;Cesana G;Leoni V;Palmieri L;Donfrancesco C;Ojeda F;Linneberg A;Söderberg S;Iacoviello L;Gianfagna F;Costanzo S;Sans S;Veronesi G;Thorand B;Peters A;Tunstall-Pedoe H;Kee F;Salomaa V;Schnabel RB;Kuulasmaa K;Blankenberg S;Waldeyer C;Koenig W; ;
{Journal}: J Am Coll Cardiol
{Volume}: 84
{Issue}: 2
{Year}: 2024 Jul 9
{Factor}: 27.203
{DOI}: 10.1016/j.jacc.2024.04.050
{Abstract}: <B>BACKGROUND: </B>Conventional low-density lipoprotein cholesterol (LDL-C) quantification includes cholesterol attributable to lipoprotein(a) (Lp(a)-C) due to their overlapping densities.<BR><B>OBJECTIVE: </B>The purposes of this study were to compare the association between LDL-C and LDL-C corrected for Lp(a)-C (LDLLp(a)corr) with incident coronary heart disease (CHD) in the general population and to investigate whether concomitant Lp(a) values influence the association of LDL-C or apolipoprotein B (apoB) with coronary events.<BR><B>METHODS: </B>Among 68,748 CHD-free subjects at baseline LDLLp(a)corr was calculated as "LDL-C-Lp(a)-C," where Lp(a)-C was 30% or 17.3% of total Lp(a) mass. Fine and Gray competing risk-adjusted models were applied for the association between the outcome incident CHD and: 1) LDL-C and LDLLp(a)corr in the total sample; and 2) LDL-C and apoB after stratification by Lp(a) mass (≥/<90th percentile).<BR><B>RESULTS: </B>Similar risk estimates for incident CHD were found for LDL-C and LDL-CLp(a)corr30 or LDL-CLp(a)corr17.3 (subdistribution HR with 95% CI) were 2.73 (95% CI: 2.34-3.20) vs 2.51 (95% CI: 2.15-2.93) vs 2.64 (95% CI: 2.26-3.10), respectively (top vs bottom fifth; fully adjusted models). Categorization by Lp(a) mass resulted in higher subdistribution HRs for uncorrected LDL-C and incident CHD at Lp(a) ≥90th percentile (4.38 [95% CI: 2.08-9.22]) vs 2.60 [95% CI: 2.21-3.07]) at Lp(a) <90th percentile (top vs bottom fifth; Pinteraction0.39). In contrast, apoB risk estimates were lower in subjects with higher Lp(a) mass (2.43 [95% CI: 1.34-4.40]) than in Lp(a) <90th percentile (3.34 [95% CI: 2.78-4.01]) (Pinteraction0.49).<BR><B>CONCLUSIONS: </B>Correction of LDL-C for its Lp(a)-C content provided no meaningful information on CHD-risk estimation at the population level. Simple categorization of Lp(a) mass (≥/<90th percentile) influenced the association between LDL-C or apoB with future CHD mostly at higher Lp(a) levels.