Abstract 19363: Elevated Lp(a) Levels Strongly Increase the Risk for Cardiovascular Disease in Patients With Familial Hypercholesterolemia
Introduction: Several studies have suggested that elevated levels of Lp(a) is a strong and independent risk factor for cardiovascular disease (CVD) in the general population. We and others have previously demonstrated that high Lp(a) levels is a CVD risk factor in familial hypercholesterolemia (FH) patients. This may suggest that high Lp(a) levels leads to a more aggressive phenotype in presence of a high LDL-cholesterol (LDL-C), which falls in line with clinical treatment of high Lp(a) often consisting of statin treatment to reduce the progression of atherosclerosis.
Hypothesis: In patients with FH, to investigate if CVD was more prevalent in patients with Lp(a) ≥ 900 mg/L than in those with Lp(a) levels < 900 mg/L despite otherwise similar cholesterol burden.
Methods: Retrospective collection of data from medical charts of patients with FH followed at lipid clinics in Norway.
Results: All data are presented as mean (standard deviation) unless otherwise stated. In total, 614 adult FH patients with Lp(a) measurements were included in the study. FH patients with Lp(a) levels < 900 mg/L (n=515) was compared to FH patients with Lp(a) ≥ 900 mg/L (n=99). The two groups were otherwise similar in cholesterol burden in terms of age of FH diagnosis (30.2 [15.7] vs. 29.6 [15.2] years, P=0.748), age at start of lipid-lowering treatment (31.2 [12.4] vs. 33.2 [12.2] years, P=0.233), pretreatment LDL-C (6.8 [1.9] vs. 6.7 [1.9] mmol/L, P=0.726) and on-treatment LDL-C (3.4 [1.3] vs. 3.3 [1.2] mmol/L, P=0.716). The Lp(a) < 900 group had Lp(a) levels of median 196 (range 10-894) mg/L, and the Lp(a) > 900 group had levels of median 1200 (range 900-3180) mg/L, P<0.001. The Lp(a) ≥ 900 group had significantly higher prevalence of CVD (35.6 %) compared with the Lp(a) < 900 group (14.0 %), P<0.001. CVD was defined as cardiac bypass surgery (8.1% vs. 2.5%, P<0.05), clinical diagnosis of angina pectoris (9.1% vs. 4.1%; P< 0.05), percutaneous coronary intervention (3.0% vs. 1.4%, P>0.2) and myocardial infarction (12.1% vs. 6.0%; P<0.05), in the Lp(a) ≥ 900 and Lp(a) < 900 group, respectively.
Conclusions: Elevated Lp(a) levels severely aggravates the FH phenotype by increasing the prevalence of CVD. This may suggest that high Lp(a) is more important in presence of a high LDL-C.
Author Disclosures: K.B. Holven: Research Grant; Significant; Tine, Mills, Olympic Seafood. Other Research Support; Significant; Sanofi, Amgen. Consultant/Advisory Board; Modest; Pronova and Amgen. A. Græsdal: Honoraria; Modest; MSD, Sanofi, Amgen. G. Langslet: Honoraria; Modest; from Amgen, Sanofi, Boehringer, Janssen. Consultant/Advisory Board; Modest; from Amgen, Sanofi, Boehringer, Janssen. A. Hovland: Research Grant; Modest; Amgen. Honoraria; Modest; Amgen, Sanofi. K. Retterstøl: Honoraria; Modest; Merck, Pfizer, Mills DA, Melk.no, Apotek1, Pronova, Amgen, Genzyme, and Sanofi. L. Mundal: None. D. Johansen: Honoraria; Modest; MSD. M.P. Bogsrud: Other Research Support; Significant; Amgen, Sanofi. Honoraria; Modest; Amgen, MSD, Sanofi. Consultant/Advisory Board; Modest; Amgen.
- © 2016 by American Heart Association, Inc.