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Lipoprotein(a) and abdominal aortic aneurysm risk: The Atherosclerosis Risk in Communities study.

ABSTRACT: BACKGROUND AND AIMS:No prospective study has investigated whether elevated lipoprotein(a) concentrations are associated with an increased risk of abdominal aortic aneurysm (AAA). We aimed to prospectively investigate this association. METHODS:In 1987-1989, the Atherosclerosis Risk in Communities study measured plasma lipoprotein(a) in 13,683 participants aged 45-64 years, without a history of AAA surgery. We followed them for incident, clinical AAA events through 2011. RESULTS:During the 272,914 person-years of follow-up, over a median of 22.6 years, we documented 505 incident AAA events. The age-, sex-, and race-adjusted model showed that individuals in the highest quintile of plasma lipoprotein(a) had an increased risk of AAA. Further adjustment for the other potential confounding factors, including other plasma lipids (high- and low-density lipoprotein cholesterol and triglyceride concentrations), attenuated the association, but individuals in the highest versus lowest quintile of plasma lipoprotein(a) still had a significantly increased risk of AAA [hazard ratio (95% confidence interval): 1.57 (1.19-2.08)]. Interaction testing suggested no difference in the associations for whites and African Americans (p for interaction = 0.96). A restricted cubic spline analysis demonstrated a positive dose-response relation of plasma lipoprotein(a) with AAA, with a steep increase in AAA risk above the 75th percentile (p for overall association = 0.0086, p for non-linear association = 0.097). CONCLUSIONS:In this population-based cohort study, elevated lipoprotein(a) concentrations were independently associated with an increased risk of AAA. The association reflected a threshold of increased AAA risk at high lipoprotein(a) concentrations, rather than a steady monotonic association.

SUBMITTER: Kubota Y

PROVIDER: S-EPMC5788200 | biostudies-literature | 2018 Jan

REPOSITORIES: biostudies-literature

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Lipoprotein(a) and abdominal aortic aneurysm risk: The Atherosclerosis Risk in Communities study.

Kubota Yasuhiko Y Folsom Aaron R AR Ballantyne Christie M CM Tang Weihong W

Atherosclerosis 20171126

<h4>Background and aims</h4>No prospective study has investigated whether elevated lipoprotein(a) concentrations are associated with an increased risk of abdominal aortic aneurysm (AAA). We aimed to prospectively investigate this association.<h4>Methods</h4>In 1987-1989, the Atherosclerosis Risk in Communities study measured plasma lipoprotein(a) in 13,683 participants aged 45-64 years, without a history of AAA surgery. We followed them for incident, clinical AAA events through 2011.<h4>Results< ...[more]

PMID: 29182987

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Project description:ObjectiveFew studies have prospectively examined the associations of lipoprotein(a) [Lp(a)] levels with the risk of abdominal aortic aneurysm (AAA), especially in women. Accounting for commonly recognized risk factors, we investigated the baseline Lp(a) levels and the risk of AAA among postmenopausal women participating in the ongoing national Women's Health Initiative.MethodsWomen's Health Initiative participants with baseline Lp(a) levels available who were beneficiaries of Medicare parts A and B fee-for-service at study enrollment or who had aged into Medicare at any point were included. Participants with missing covariate data or known AAA at baseline were excluded. Thoracic aneurysms were excluded owing to the different pathophysiology. The AAA cases and interventions were identified using the International Classification of Diseases, 9th and 10th revision, codes and Current Procedural Terminology codes from claims data. Hazard ratios were computed using Cox proportional hazard models according to the quintiles of Lp(a).ResultsThe mean age of the 6615 participants included in the analysis was 65.3 years. Of the 6615 participants, 66.6% were non-Hispanic white, 18.9% were black, 7% were Hispanic and 4.7% were Asian/Pacific Islander. Compared with the participants in the lowest Lp(a) quintile, those in higher quintiles were more likely to be overweight, black, and former or current smokers, to have hypertension, hyperlipidemia, and a history of cardiovascular disease, and to use menopausal hormone therapy and statins. During 65,476 person-years of follow-up, with a median of 10.4 years, 415 women had been diagnosed with an AAA and 36 had required intervention. More than one half had required intervention for a ruptured AAA. We failed to find a statistically significant association between Lp(a) levels and incident AAA. Additional sensitivity analyses stratified by race, with exclusion of statin users and alternative categorizations of Lp(a) using log-transformed levels, tertiles, and a cutoff of >50 mg/dL, were conducted, which did not reveal any significant associations.ConclusionsWe found no statistically significant association between Lp(a) levels and the risk of AAA in a large and well-phenotyped sample of postmenopausal women. Women with high Lp(a) levels were more likely to be overweight, black, and former or current smokers, and to have hypertension, hyperlipidemia, and a history of cardiovascular disease, or to use hormone therapy and statins compared with those with lower Lp(a) levels. These findings differ from previous prospective, case-control, and meta-analysis studies that had supported a significant relationship between higher Lp(a) levels and an increased risk of AAA. Differences in the association could have resulted from study limitations or sex differences.

Dataset Information

Lipoprotein(a) and abdominal aortic aneurysm risk: The Atherosclerosis Risk in Communities study.

Publications

Lipoprotein(a) and abdominal aortic aneurysm risk: The Atherosclerosis Risk in Communities study.

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