LIPOPROTEIN(A) IS ASSOCIATED WITH INCIDENT HEART FAILURE HOSPITALIZATION: ARIC STUDY

1852 JACC April 5, 2016 Volume 67, Issue 13

Prevention LIPOPROTEIN(A) IS ASSOCIATED WITH INCIDENT HEART FAILURE HOSPITALIZATION: ARIC STUDY Moderated Poster Contributions Prevention Moderated Poster Theater, Poster Area, South Hall A1 Sunday, April 03, 2016, 12:45 p.m.-12:55 p.m. Session Title: Evolving Science in Lipidology: Observations and Interventions Abstract Category: 33. Prevention: Clinical Presentation Number: 1213M-03 Authors: Anandita Agarwala, Yashashwi Pokharel, Salim Virani, Wensheng Sun, Chiadi Ndumele, Eyal Shahar, Gerardo Heiss, Eric Boerwinkle, Suma Konety, Ron Hoogeveen, Christie Ballantyne, Baylor College of Medicine, Houston, TX, USA

Background: Lipoprotein (a) [Lp(a)] is a proatherogenic lipoprotein and a risk factor for coronary heart disease (CHD). Given the limited data on its association with incident heart failure (HF), we examined the association of Lp(a) levels with incident HF hospitalization in the Atherosclerosis Risk in Communities (ARIC) study.

Methods: Lp(a) was measured in 14,154 ARIC participants without prevalent HF in the visit 1 of the study using a double-antibody enzymelinked immunosorbent assay technique. The median follow-up period was 23.4 years. The association of Lp(a) quintiles (Q) with incident HF hospitalization was assessed using Cox proportional hazards. Subgroup analyses were performed by race, gender, and diabetes. Results: Elevated levels of Lp(a) were positively associated with incident HF hospitalization when adjusted for risk factors/markers. However, when additionally adjusted for prevalent CHD, the association was attenuated. There was no significant interaction by race, gender or diabetes (p for interaction for all >0.05).

Conclusions: Elevated Lp(a) levels were associated with an increased risk of incident HF hospitalization, however, this effect appears to be mainly mediated by CHD. Table: Association of Lp(a) with Incident Heart Failure Hospitalization Quintile

Lp(a) range (mg/dL)

1

2

3

4

5

P trend

0.1-1.9

2.0-4.3

4.4-8.6

8.7-17.4

17.5-81.7

-

479/2943 447/2742

502/2815

583/2825

594/2829

-

Model 1 (N=14,154)

Ref

1.02 (0.90,1.17)

1.09 (0.96,1.24)

1.21 (1.07,1.38)

1.24 (1.09,1.41)

0.002

Model 2

Ref

1.04 (0.91,1.19)

1.10 (0.96,1.25)

1.22 (1.07,1.38)

1.19 (1.05,1.36)

0.01

N heart failure events/ N Quintile

Abbreviations: Coronary Heart Disease (CHD), Body mass index (BMI), High-density lipoprotein cholesterol (HDL-C), Lipoprotein(a) [Lp(a)] Data is presented as hazard ratio and 95% confidence interval P trend tests a linear increase in log relative hazard with increasing quintiles. Model 1. Adjusted variables include: age, gender, race, systolic blood pressure, hypertension, diabetes, current smoking, BMI, and heart rate, and HDL-C Model 2. Adjusted for variables in model 1 plus prevalent CHD