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Association of lipoprotein(a) with all-cause and cause-specific mortality: A prospective cohort study

  • Author Footnotes
    1 Zhen-Wei Wang, Min Li and Jing-Jie Li contributed equally to this work.
    Zhen-Wei Wang
    Footnotes
    1 Zhen-Wei Wang, Min Li and Jing-Jie Li contributed equally to this work.
    Affiliations
    Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
    Search for articles by this author
  • Author Footnotes
    1 Zhen-Wei Wang, Min Li and Jing-Jie Li contributed equally to this work.
    Min Li
    Footnotes
    1 Zhen-Wei Wang, Min Li and Jing-Jie Li contributed equally to this work.
    Affiliations
    Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
    Search for articles by this author
  • Author Footnotes
    1 Zhen-Wei Wang, Min Li and Jing-Jie Li contributed equally to this work.
    Jing-Jie Li
    Footnotes
    1 Zhen-Wei Wang, Min Li and Jing-Jie Li contributed equally to this work.
    Affiliations
    Department of Hematology and Oncology, Affiliated Xuchang People's Hospital of Xinxiang Medical College, Xuchang, China
    Search for articles by this author
  • Nai-Feng Liu
    Correspondence
    Corresponding author.
    Affiliations
    Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
    Search for articles by this author
  • Author Footnotes
    1 Zhen-Wei Wang, Min Li and Jing-Jie Li contributed equally to this work.
Published:September 18, 2022DOI:https://doi.org/10.1016/j.ejim.2022.09.010

      Highlights

      • Lp(a) was closely associated with all-cause and cause-specific mortality.
      • Lp(a) was linearly associated with all-cause and cause-specific mortality.
      • The association between Lp(a) and mortality remained robust in some populations.

      Abstract

      Background

      A growing number of studies have demonstrated a causal association between lipoprotein(a) [Lp(a)] and atherosclerotic cardiovascular diseases (ASCVDs), but its association with all-cause and cause-specific mortality remains unclear. Therefore, this study aimed to explore the association of Lp(a) with all-cause and cause-specific mortality.

      Methods

      This prospective cohort study included 8,525 participants from the third National Health and Nutrition Examination Survey. Lp(a) was considered an exposure variable, all-cause and cause-specific mortality were used as outcome variables, and all participants were followed from the interview date until death or December 31, 2015. COX proportional hazards regression models, stratified analysis, sensitivity analysis, restricted cubic spline plots and Kaplan-Meier survival curves were used to analyze the association of Lp(a) with all-cause and cause-specific mortality.

      Results

      After adjusting for traditional cardiovascular risk factors, Lp(a) remained strongly associated with all-cause and CVDs-related mortality (P for trend = 0.007 and < 0.001). Subgroup analyses showed that higher Lp(a) remained associated with higher risk of all-cause mortality in those > 60 years of age, with a BMI < 30 kg/m2, and without diabetes, whereas the association between Lp(a) and CVDs-related mortality remained stable in participants ≤ 60 years of age, male, with a BMI < 30 kg/m2, with hypertension, without diabetes, or without CVDs (P < 0.05). In sensitivity analyses, we found that the association of Lp(a) with all-cause and CVDs-related mortality remained robust after excluding individuals who died within one year of follow-up (P for trend = 0.041 and 0.002).

      Conclusions

      Lp(a) was associated with the risk of all-cause and CVDs-related mortality.

      Keywords

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