Abstract
BackgroundElevated lipoprotein(a) [Lp(a)] and fibrinogen (Fib) are both associated with coronary artery disease (CAD). The atherogenicity of Lp(a) can be partly due to the potentially antifibrinolytic categories. We hypothesize that patients with higher Lp(a) and Fib may have worse outcomes.MethodsIn this prospective study, we consecutively enrolled 8,417 Chinese patients with stable CAD from March 2011 to March 2017. All subjects were divided into 9 groups according to Lp(a) (Lp(a)-Low, Lp(a)-Medium, Lp(a)-High) and Fib levels (Fib-Low, Fib-Medium, Fib-High) and followed up for CVEs, including nonfatal acute myocardial infarction, stroke, and cardiovascular mortality. Kaplan–Meier, Cox regression and C-statistic analyses were performed.ResultsDuring a median of 37.1 months’ follow-up, 395 (4.7%) CVEs occurred. The occurrence of CVEs increased by Lp(a) (3.5 vs. 5.3 vs. 5.6%, p = 0.001) and Fib (4.0 vs. 4.4 vs. 6.1%, p < 0.001) categories. When further classified into 9 groups by Lp(a) and Fib levels, the CVEs were highest in the 9th (Lp(a)-High and Fib-High) compared with the 1st (Lp(a)-Low and Fib-Low) group (7.2 vs. 3.3%, p < 0.001). The highest risk of subsequent CVEs was found in the 9th group (HRadjusted 2.656, 95% CI 1.628–4.333, p < 0.001), which was more significant than Lp(a)-High (HRadjusted 1.786, 95% CI 1.315–2.426, p < 0.001) or Fib-High (HRadjusted 1.558, 95% CI 1.162–2.089, p = 0.003) group. Moreover, adding the combined Lp(a) and Fib increased the C-statistic by 0.013.ConclusionCombining Fib and Lp(a) enhance the prognostic value for incident CVEs beyond Lp(a) or Fib alone.
Highlights
Elevated lipoprotein(a) [Lp(a)] and fibrinogen (Fib) are both associated with coronary artery disease (CAD)
The rate of statin usage was lower (p = 0.005) at admission while balanced (p > 0.05) at discharge in cardiovascular events (CVEs) compared with patients without events
The hazard ratios (HRs) of baseline characteristics with future CVEs were presented in Additional file 1
Summary
Elevated lipoprotein(a) [Lp(a)] and fibrinogen (Fib) are both associated with coronary artery disease (CAD). Despite significant advances in the diagnosis and therapy of cardiovascular disease (CVD), patients with established coronary artery disease (CAD) are generally at higher risk of developing recurrent cardiovascular events (CVEs) than the primary prevention individuals [1]. As a result, identifying additional modifiable risk factors is necessary to further improve CVEs prediction in the management of patients with established CAD. Unlike apolipoprotein B, apo(a) does not contain lipid domains or transport lipid, but instead, it potentiates atherothrombosis through additional pathways including proinflammatory, and potentially antifibrinolytic effects by inhibiting plasminogen activation [10]. Little is known about the interrelationship of Lp(a) and Fib in the CVEs risk prediction in the secondary prevention setting
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