Abstract 19067: Lipoprotein(a) and Risk of Cardiovascular Disease in Persons With Chronic Kidney Disease: Findings From the Chronic Renal Insufficiency Cohort Study
Introduction: Elevated lipoprotein(a) [Lp(a)] levels are associated with increased cardiovascular disease (CVD) risk in the general population. While Lp(a) levels are increased in patients with chronic kidney disease (CKD), its impact on CVD events in CKD remains less clear.
Hypothesis: Higher Lp(a) level is independently associated with higher risk for atherosclerotic CVD [myocardial infarction (MI) and ischemic stroke] and death in CKD.
Methods: The Chronic Renal Insufficiency Cohort (CRIC) is a prospective cohort study of adults with CKD. In primary analyses, we compared quartiles of Lp(a) with the risks for MI, ischemic stroke, and death using Cox proportional hazards regression. We used Fine and Gray methods to address potential effects of death as a competing risk in analyses of CVD events. In secondary analyses, we excluded participants with previous MI or stroke.
Results: Among 3744 participants (55% men, 59% non-White) with mean age 57.7±11.0 years, 317 had an MI, 42 had an ischemic stroke, and 822 died over a median follow-up of 7.5 years. Participants were divided into quartiles of baseline Lp(a) levels (mg/dL): <9.8 (low), 9.8-26.0 (middle), 26.1-61.3 (high), and >61.3 (very high). The middle group was used as the reference category. After adjustment for age, sex, race and study site, the hazard ratio (HR, 95% CI) of CVD events and death for very high Lp(a) was 1.35 (1.13-1.61). After further adjustment for other potential confounders, very high Lp(a) remained significantly associated with death (HR 1.24, 1.01-1.54) as was high Lp(a) for MI (HR 1.44, 1.02-2.03). We did not find an association between Lp(a) level and ischemic stroke. In secondary analyses of 1100 participants with no prior history of CVD, very high Lp(a) was significantly associated with combined CVD events and death in the fully-adjusted model (HR 1.33, 1.02-1.73).
Conclusion: High levels of Lp(a) in CKD are independently associated with higher risks for CVD and death.
Author Disclosures: A. Bajaj: None. S.M. Damrauer: None. A.H. Anderson: None. A.S. Go: None. W.S. Post: None. J.P. Lash: None. J. He: None. M.J. Budoff: Research Grant; Significant; NIH, GE. D. Saleheen: None. J. Chen: None. D.J. Rader: None.
- © 2016 by American Heart Association, Inc.