Elevated lipoprotein(a) and prevalent cardiovascular disease burden in treated hypertension.
TL;DR
In adults with treated HTN, elevated Lp(a) was independently associated with prevalent cardiovascular disease burden after adjustment for office BP control and conventional cardiovascular risk factors, and the potential role of Lp(a) assessment in refining cardiovascular risk stratification in treated hypertensive populations is supported.
Abstract
Background
Elevated lipoprotein(a) [Lp(a)] is associated with atherosclerotic cardiovascular disease across multiple clinical settings, but its relationship with prevalent cardiovascular disease burden among adults with treated hypertension (HTN) remains incompletely characterized.
Objective
To evaluate the association between elevated Lp(a) levels and prevalent cardiovascular disease burden among adults with treated HTN after adjustment for contemporaneous office blood pressure (BP) control.
Methods
We performed a predefined cross-sectional subanalysis of the multicenter Argentine Group for the Study of Lp(a) cohort, including adults with treated HTN and available Lp(a) measurements. BP control was defined as office BP ≤130/80 mmHg. Lp(a) was analyzed as a continuous variable using a high-risk threshold of ≥125 nmol/L. Multivariable generalized estimating equation models adjusted for age, sex, diabetes mellitus, smoking status, low-density lipoprotein-cholesterol, statin therapy, and BP control were used to evaluate the association between Lp(a) and prevalent cardiovascular disease burden.
Results
Among 2313 patients with treated HTN, higher Lp(a) levels were independently associated with a greater prevalence of cardiovascular disease burden. Each 1-SD increase in log-transformed Lp(a) was associated with higher odds of prevalent cardiovascular disease burden (Odds ratio [OR] 1.24; 95% CI 1.09-1.41; P = .001). Participants with Lp(a) ≥125 nmol/L had significantly higher odds of prevalent cardiovascular disease burden (OR 1.38; 95% CI 1.02-1.88; P = .037). Additional adjustment for body mass index and ethnicity yielded consistent results. No significant interaction was observed between Lp(a) levels and BP control status.
Conclusion
In adults with treated HTN, elevated Lp(a) was independently associated with prevalent cardiovascular disease burden after adjustment for office BP control and conventional cardiovascular risk factors. These findings support the potential role of Lp(a) assessment in refining cardiovascular risk stratification in treated hypertensive populations.