{"title":"Residual lipoprotein(a)-associated risk in patients with stroke or transient ischemic attack","authors":"Takao Hoshino , Takafumi Mizuno , Satoko Arai , Megumi Hosoya , Sho Wako , Shuntaro Takahashi , Rie Oshima , Eiko Higuchi , Kentaro Ishizuka , Sono Toi , Kenichi Todo","doi":"10.1016/j.atherosclerosis.2025.119231","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and aims</h3><div>Lipoprotein (a) [Lp(a)] is a genetically determined risk factor for atherosclerotic cardiovascular diseases. This study aimed to evaluate the association of serum Lp(a) levels with the risk of residual vascular event risk after stroke or transient ischemic attack (TIA) in the Japanese population.</div></div><div><h3>Methods</h3><div>In this prospective observational study, 533 patients (mean age, 70.7 years; female, 41.8 %) with ischemic stroke (n = 496) or high-risk TIA (n = 37) were consecutively enrolled within 1 week of onset and followed up for 1 year. Patients were divided into 2 groups according to the median baseline Lp(a) levels: (i) low (≤15 mg/dL, n = 270) and (ii) high (>15 mg/dL, n = 263) Lp(a) groups. The primary endpoint was a composite of major adverse cardiovascular events (MACEs), including nonfatal stroke, nonfatal acute coronary syndrome, and vascular death.</div></div><div><h3>Results</h3><div>Compared to patients with Lp(a) ≤15 mg/dL, those with Lp(a) > 15 mg/dL were more likely to have extracranial carotid artery stenosis (8.8 % versus 15.2 %; <em>p</em> = 0.024) and a history of coronary artery disease (7.8 % versus 14.1 %; <em>p</em> = 0.019). Elevated Lp(a) levels were independently associated with an increased risk of MACE (annual rate, 10.7 % versus 19.1 %; log-rank <em>p</em> = 0.009; adjusted hazard ratio, 1.68; 95 % confidence interval, 1.03–2.72; <em>p</em> = 0.037). When patients were classified according to the etiologic subtype of the index event, elevated Lp(a) was a significant predictor of MACE in patients with atherothrombotic stroke (annual rate, 14.0 % versus 25.8 %; log-rank <em>p</em> = 0.041), but not in those with small vessel disease, cardioembolism, or cryptogenic stroke.</div></div><div><h3>Conclusions</h3><div>Elevated Lp(a) levels >15 mg/dL in Japanese patients with stroke are associated with extracranial carotid stenosis and a higher risk of MACE. The measurement of Lp(a) levels helped refine the risk assessment of patients with stroke or TIA.</div></div>","PeriodicalId":8623,"journal":{"name":"Atherosclerosis","volume":"405 ","pages":"Article 119231"},"PeriodicalIF":5.7000,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Atherosclerosis","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0021915025001297","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background and aims
Lipoprotein (a) [Lp(a)] is a genetically determined risk factor for atherosclerotic cardiovascular diseases. This study aimed to evaluate the association of serum Lp(a) levels with the risk of residual vascular event risk after stroke or transient ischemic attack (TIA) in the Japanese population.
Methods
In this prospective observational study, 533 patients (mean age, 70.7 years; female, 41.8 %) with ischemic stroke (n = 496) or high-risk TIA (n = 37) were consecutively enrolled within 1 week of onset and followed up for 1 year. Patients were divided into 2 groups according to the median baseline Lp(a) levels: (i) low (≤15 mg/dL, n = 270) and (ii) high (>15 mg/dL, n = 263) Lp(a) groups. The primary endpoint was a composite of major adverse cardiovascular events (MACEs), including nonfatal stroke, nonfatal acute coronary syndrome, and vascular death.
Results
Compared to patients with Lp(a) ≤15 mg/dL, those with Lp(a) > 15 mg/dL were more likely to have extracranial carotid artery stenosis (8.8 % versus 15.2 %; p = 0.024) and a history of coronary artery disease (7.8 % versus 14.1 %; p = 0.019). Elevated Lp(a) levels were independently associated with an increased risk of MACE (annual rate, 10.7 % versus 19.1 %; log-rank p = 0.009; adjusted hazard ratio, 1.68; 95 % confidence interval, 1.03–2.72; p = 0.037). When patients were classified according to the etiologic subtype of the index event, elevated Lp(a) was a significant predictor of MACE in patients with atherothrombotic stroke (annual rate, 14.0 % versus 25.8 %; log-rank p = 0.041), but not in those with small vessel disease, cardioembolism, or cryptogenic stroke.
Conclusions
Elevated Lp(a) levels >15 mg/dL in Japanese patients with stroke are associated with extracranial carotid stenosis and a higher risk of MACE. The measurement of Lp(a) levels helped refine the risk assessment of patients with stroke or TIA.
期刊介绍:
Atherosclerosis has an open access mirror journal Atherosclerosis: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review.
Atherosclerosis brings together, from all sources, papers concerned with investigation on atherosclerosis, its risk factors and clinical manifestations. Atherosclerosis covers basic and translational, clinical and population research approaches to arterial and vascular biology and disease, as well as their risk factors including: disturbances of lipid and lipoprotein metabolism, diabetes and hypertension, thrombosis, and inflammation. The Editors are interested in original or review papers dealing with the pathogenesis, environmental, genetic and epigenetic basis, diagnosis or treatment of atherosclerosis and related diseases as well as their risk factors.