Abstract 9381: Lipoprotein(a), Oxidized Phospholipids, and Coronary Artery Disease Severity and Outcomes

Abstract

Introduction: Lipoprotein(a) [Lp(a)] and related oxidized phospholipids (OxPLs) are independent risk factors for atherosclerotic cardiovascular disease. The extent to which Lp(a) and OxPLs together predict coronary artery disease (CAD) severity and outcomes is unclear. We measured Lp(a) isoform-independent particle number and OxPLs associated with apolipoprotein(a) [OxPL-apo(a)] and apolipoprotein-B (OxPL-apoB) among participants in CASABLANCA (ClinicalTrials.gov NCT00842868), a contemporary cath-based registry, and assessed angiographic CAD at baseline and CV events in follow-up. Methods: In 1098 participants undergoing baseline coronary angiography, logistic regression estimated odds of any CAD (≥1 severe coronary stenosis) or multi-vessel CAD (≥2 severe coronary stenoses). Cox proportional hazards regression estimated risk of major adverse cardiovascular events (MACE: non-fatal MI, non-fatal stroke, CV death, or coronary revascularization) over median 4.2 years. Models were adjusted for age, sex, medical history, cholesterol, smoking, and statin use. Results: Median [IQR] Lp(a) was 26.45 nmol/L [11.39-89.49]. Lp(a), OxPL-apoB, and OxPL-apo(a) were highly correlated (Spearman R≥0.91 for all pairwise combinations). Biomarkers were not associated with any CAD, but Lp(a) and OxPL-apoB were associated with multi-vessel CAD. All biomarkers were associated with CV events. Odds of multi-vessel CAD per doubling of Lp(a), OxPL-apoB, and OxPL-apo(a) were 1.10 (95% CI 1.03-1.18, P=0.006), 1.18 (95% CI 1.03-1.34, P=0.01), and 1.07 (95% CI 0.99-1.16, P=0.07), respectively ( Figure, A ). Hazard ratios for MACE per doubling of Lp(a), OxPL-apoB, and OxPL-apo(a) were 1.08 (95% CI 1.03-1.14, P=0.001), 1.15 (95% CI 1.05-1.26, P=0.004), and 1.07 (95% CI 1.01-1.14, P=0.02), respectively ( Figure, B ). Conclusions: Lp(a) and OxPL-apoB are associated with multi-vessel CAD. Lp(a), OxPL-apoB, and OxPL-apo(a) are associated with incident CV events.