China: Study on Lipoprotein(a) and hsCRP in CAD Patients Undergoing PCI

In coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI), a high level of lipoprotein(a) is associated with worse outcomes. In those with concomitant high-sensitivity C-reactive protein (hsCRP), the association might be more substantial, a recent study has stated.

The findings, published in the journal Atherosclerosis, imply that simultaneous evaluation of hsCRP and Lp(a) may help identify high-risk patients for targeted intervention in clinical utility.

Study Overview

There needs to be clarity on the effects of hsCRP on Lp(a)-associated cardiovascular risk in CAD patients undergoing PCI. Deshan Yuan, from the Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China, and colleagues conducted the study to examine the independent and combined Lp(a) and hsCRP association with cardiovascular events in this particular population in a prospective cohort study.

The study included 10,424 patients with both Lp(a) and hsCRP measurements. To investigate the relationship between hsCRP, Lp(a), and adverse cardiac and cerebrovascular events (all-cause death, MACE, ischemic stroke, myocardial infarction, and revascularization), the researchers performed Cox proportional hazards models, and Kaplan-Meier analysis was performed.

Key Findings

• 20.5% of MACCE occurred during five years of follow-up.
• Increased levels of Lp(a) and hsCRP were associated with increased risks of MACCE.
• There might be a remarkable interaction between Lp(a) and hsCRP.
• The researchers observed a significantly higher risk of MACCE with Lp(a) 15–29.9 mg/dL (HR: 1.18) and Lp(a) ≥30 mg/dL (HR: 1.20) in the setting of hsCRP ≥2 mg/L. When hsCRP was <2 mg/L with Lp(a) 15–29.9 mg/dL (HR: 0.94) and Lp(a) ≥30 mg/dL (HR: 1.12), such association was attenuated.
• Patients with a dual elevation of these two biomarkers had a significantly higher MACCE risk compared with the reference group (Lp(a) < 15 mg/dL and hsCRP <2 mg/L) when Lp(a) and hsCRP were combined for risk stratification.
• Increased Lp(a) and hsCRP are individually associated with an increased risk of cardiovascular events. In patients with higher hsCRP concentrations, the association between Lp(a) and cardiovascular risk might be stronger.

The findings led researchers to conclude that concurrent evaluation of Lp(a) and hsCRP may help risk stratification.

Reference

https://doi.org/10.1016/j.atherosclerosis.2022.10.013