학술논문
Lipoprotein(a) and the pooled cohort equations for ASCVD risk prediction: The Multi-Ethnic Study of Atherosclerosis.
Document Type
Academic Journal
Author
Bhatia HS; Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA.; Rikhi R; Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA.; Allen TS; Division of Preventive Medicine, Department of Family Medicine, University of California, San Diego, La Jolla, CA, USA.; Yeang C; Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA.; Guan W; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA.; Garg PK; Division of Cardiology, Department of Medicine, University of Southern California, Los Angeles, CA, USA.; Tsai MY; Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA.; Criqui MH; Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA; Division of Preventive Medicine, Department of Family Medicine, University of California, San Diego, La Jolla, CA, USA.; Shapiro MD; Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC, USA.; Tsimikas S; Division of Cardiology, Department of Medicine, University of California San Diego, La Jolla, CA, USA. Electronic address: stsimikas@health.ucsd.edu.
Source
Publisher: Elsevier Country of Publication: Ireland NLM ID: 0242543 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-1484 (Electronic) Linking ISSN: 00219150 NLM ISO Abbreviation: Atherosclerosis Subsets: MEDLINE
Subject
Language
English
Abstract
Background and Aims: Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD) but is not included in the Pooled Cohort Equations (PCE). We aimed to assess how well the PCE predict 10-year event rates in individuals with elevated Lp(a), and whether the addition of Lp(a) improves risk prediction.
Methods: We compared observed versus PCE-predicted 10-year ASCVD event rates, stratified by Lp(a) level and ASCVD risk category using Poisson regression, and evaluated the association between Lp(a) > 50 mg/dL and ASCVD risk using Cox proportional hazards models in the Multi-Ethnic Study of Atherosclerosis (MESA). We evaluated the C-index and net reclassification improvement (NRI) with addition of Lp(a) to the PCE.
Results: The study population included 6639 individuals (20%, n = 1325 with elevated Lp(a)). The PCE accurately predicted 10-year event rates for individuals with elevated Lp(a) with observed event rates falling within predicted limits. Elevated Lp(a) was associated with increased risk of CVD events overall (HR 1.27, 95% CI 1.00-1.60), particularly in low (HR 2.45, 95% CI 1.40-4.31), and high-risk (HR 1.41, 95% CI 1.02-1.96) individuals. Continuous NRI (95% CI) with the addition of Lp(a) to the PCE for CVD was 0.0963 (0.0158-0.1953) overall, and 0.2999 (0.0876, 0.5525) among low-risk individuals.
Conclusions: The PCE performs well for event rate prediction in individuals with elevated Lp(a). However, Lp(a) is associated with increased CVD risk, and the addition of Lp(a) to the PCE improves risk prediction, particularly among low-risk individuals. These results lend support for increasing use of Lp(a) testing for risk assessment.
(Copyright © 2023 Elsevier B.V. All rights reserved.)
Methods: We compared observed versus PCE-predicted 10-year ASCVD event rates, stratified by Lp(a) level and ASCVD risk category using Poisson regression, and evaluated the association between Lp(a) > 50 mg/dL and ASCVD risk using Cox proportional hazards models in the Multi-Ethnic Study of Atherosclerosis (MESA). We evaluated the C-index and net reclassification improvement (NRI) with addition of Lp(a) to the PCE.
Results: The study population included 6639 individuals (20%, n = 1325 with elevated Lp(a)). The PCE accurately predicted 10-year event rates for individuals with elevated Lp(a) with observed event rates falling within predicted limits. Elevated Lp(a) was associated with increased risk of CVD events overall (HR 1.27, 95% CI 1.00-1.60), particularly in low (HR 2.45, 95% CI 1.40-4.31), and high-risk (HR 1.41, 95% CI 1.02-1.96) individuals. Continuous NRI (95% CI) with the addition of Lp(a) to the PCE for CVD was 0.0963 (0.0158-0.1953) overall, and 0.2999 (0.0876, 0.5525) among low-risk individuals.
Conclusions: The PCE performs well for event rate prediction in individuals with elevated Lp(a). However, Lp(a) is associated with increased CVD risk, and the addition of Lp(a) to the PCE improves risk prediction, particularly among low-risk individuals. These results lend support for increasing use of Lp(a) testing for risk assessment.
(Copyright © 2023 Elsevier B.V. All rights reserved.)