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The association of lipoprotein(a) with incident heart failure hospitalization: Atherosclerosis Risk in Communities study

  • Author Footnotes
    1 These authors contributed equally to this work.
    Anandita Agarwala
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Yashashwi Pokharel
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Mid-America Heart Institute, University of Missouri–Kansas City, Kansas City, MO, USA
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  • Anum Saeed
    Affiliations
    Center for Cardiovascular Disease Prevention, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA

    Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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  • Wensheng Sun
    Affiliations
    Center for Cardiovascular Disease Prevention, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA

    Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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  • Salim S. Virani
    Affiliations
    Center for Cardiovascular Disease Prevention, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA

    Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
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  • Vijay Nambi
    Affiliations
    Center for Cardiovascular Disease Prevention, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA

    Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA

    Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
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  • Chiadi Ndumele
    Affiliations
    Johns Hopkins University School of Medicine, Baltimore, MD, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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  • Eyal Shahar
    Affiliations
    Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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  • Gerardo Heiss
    Affiliations
    Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC, USA
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  • Eric Boerwinkle
    Affiliations
    The University of Texas Health Science Center at Houston, Houston, TX, USA

    Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
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  • Suma Konety
    Affiliations
    Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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  • Ron C. Hoogeveen
    Affiliations
    Center for Cardiovascular Disease Prevention, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA

    Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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  • Christie M. Ballantyne
    Correspondence
    Corresponding author. Baylor College of Medicine, 6565 Fannin Street, MS A601, Houston, TX 77030, USA.
    Affiliations
    Center for Cardiovascular Disease Prevention, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA

    Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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  • Author Footnotes
    1 These authors contributed equally to this work.

      Highlights

      • Lipoprotein(a) level was associated with heart failure risk in the ARIC study.
      • The association persisted after adjustment for other risk factors.
      • The relation was not significant after excluding prevalent and incident MI.
      • Lipoprotein(a) level was not associated with arterial stiffness parameters.

      Abstract

      Background and aims

      Lipoprotein(a) [Lp(a)] is a proatherogenic lipoprotein associated with coronary heart disease, ischemic stroke, and more recently aortic stenosis and heart failure (HF). We examined the association of Lp(a) levels with incident HF hospitalization in the Atherosclerosis Risk in Communities (ARIC) study. We also assessed the relationship between Lp(a) levels and arterial stiffness as a potential mechanism for development of HF.

      Methods

      Lp(a) was measured in 14,154 ARIC participants without prevalent HF at ARIC visit 1 (1987–1989). The association of Lp(a) quintiles with incident HF hospitalization was assessed using Cox proportional-hazards models. Arterial stiffness parameters were stratified based on Lp(a) quintiles, and p-trend was calculated across ordered groups.

      Results

      At a median follow-up of 23.4 years, there were 2605 incident HF hospitalizations. Lp(a) levels were directly associated with incident HF hospitalization in models adjusted for age, race, gender, systolic blood pressure, history of hypertension, diabetes, smoking status, body mass index, heart rate, and high-density lipoprotein cholesterol (quintile 5 vs. quintile 1: hazard ratio [HR] 1.24, 95% confidence interval [CI] 1.09–1.41; p-trend across increasing quintiles <0.01), but not after excluding prevalent and incident myocardial infarction cases (HR 1.07, 95% CI 0.91–1.27; p-trend = 0.70). When adjusted for age, gender, and race, Lp(a) quintiles were not significantly associated with arterial stiffness parameters.

      Conclusions

      Increased Lp(a) levels were associated with increased risk of incident HF hospitalization. After excluding prevalent and incident myocardial infarction, the association was no longer significant. Lp(a) levels were not associated with arterial stiffness parameters.

      Keywords

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