Association of lipoprotein(a) with peripheral artery disease and outcomes: A propensity-matched retrospective analysis

IF 3.6 3区医学 Q2 PHARMACOLOGY & PHARMACY

Journal of clinical lipidology Pub Date : 2025-05-01 DOI:10.1016/j.jacl.2025.04.037

Frank Annie PhD, Sarah Rinehart MD, Osman Yousafzai MD

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引用次数: 0

Abstract

Background/Synopsis

Elevated Lipoprotein(a) [Lp(a)] levels are associated with atherosclerosis and cardiovascular risk. Despite its well-established role in coronary artery disease, the impact of Lp(a) on peripheral artery disease (PAD) remains under-explored.

Objective/Purpose

This study evaluates the clinical characteristics and outcomes of Peripheral Artery Disease (PAD) patients with elevated Lp(a) compared to those without elevated Lp(a), including a matched cohort analysis.

Methods

This retrospective study included 3,397 PAD patients with elevated Lp(a) and compared them to 1,787,587 PAD patients without elevated Lp(a) from January 1, 2010, to January 25, 2025. Data were extracted from the U.S. network of the TriNetX platform. A propensity score matching approach yielded a 1:1 matched cohort (n=3,397 for each group) for balanced comparisons. Demographics, comorbidities, lipid profiles, and clinical outcomes were analyzed, with statistical significance defined as p < 0.05.

Results

In the unmatched cohort, patients with elevated Lp(a) were older (68.2 ± 12.6 vs. 65.4 ± 16.3, p < 0.01), had a higher prevalence of hypertension (80.9% vs. 51.7%, p < 0.01), CAD (50.6% vs. 23.2%, p < 0.01), diabetes (42.4% vs. 27.5%, p < 0.01), and heart failure (27.0% vs. 14.1%, p < 0.01). Post-match, there were no significant differences in age, gender distribution, or comorbidities, confirming successful matching.

At one year follow up, in the unmatched cohort patients with elevated Lp(a) exhibited higher rates of adverse outcomes, including AMI (7.9% vs. 5.6%, p=0.02), stroke (8.8% vs. 6.7%, p<0.01), and MACE (18.5% vs. 16.3%, p=0.01). However, death (4.6% vs. 7.2%, p<0.01) and Major Acute Limb Events (MALE) (3.2% vs. 5.6%, p<0.01) were lower in the Lp(a) cohort.

In the matched cohort, these differences were not statistically significant. Patients with PAD and elevated Lp(a) had significantly lower LDL and Non-HDL cholesterol levels compared to those without elevated Lp(a), suggesting better lipid control in this group. Specifically, LDL levels averaged 79.6 mg/dL vs. 82.3 mg/dL (p = 0.025), and non-HDL levels averaged 103.2 mg/dL vs. 108.2 mg/dL (p = 0.005), indicating more favorable lipid profiles in the elevated Lp(a) group.

Conclusions

PAD patients with elevated Lp(a) demonstrate significant differences in baseline characteristics and outcomes compared to those without elevated Lp(a). However, after matching, most differences in outcomes were mitigated, emphasizing the importance of Lp(a) as a potential risk marker in PAD. Despite its clinical significance, Lp(a) testing remains underutilized, highlighting the need for increased screening in PAD patients.

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脂蛋白(a)与外周动脉疾病和结局的关联：倾向匹配的回顾性分析

背景/摘要脂蛋白(a) [Lp(a)]水平升高与动脉粥样硬化和心血管风险相关。尽管Lp(a)在冠状动脉疾病中的作用已得到证实，但其对外周动脉疾病（PAD）的影响仍未得到充分探讨。目的/目的本研究评估外周动脉疾病（PAD）患者Lp(a)升高与Lp(a)未升高患者的临床特征和结局，包括匹配队列分析。方法本回顾性研究纳入了3397例Lp(a)升高的PAD患者，并将其与2010年1月1日至2025年1月25日期间未出现Lp(a)升高的1,787,587例PAD患者进行比较。数据提取自TriNetX平台的美国网络。倾向评分匹配方法产生1:1匹配队列（每组n=3,397）进行平衡比较。对人口统计学、合并症、血脂和临床结果进行分析，统计学意义定义为p <；0.05.结果在未匹配队列中，Lp(a)升高的患者年龄较大(68.2±12.6∶65.4±16.3,p <；0.01)，高血压患病率较高(80.9%比51.7%,p <；0.01), CAD (50.6% vs. 23.2%, p <；0.01)，糖尿病(42.4% vs. 27.5%, p <；0.01)和心力衰竭(27.0% vs. 14.1%, p <；0.01)。配型后，年龄、性别分布、合并症均无显著差异，证实配型成功。在一年的随访中，在未匹配的队列中，Lp(a)升高的患者表现出更高的不良结局发生率，包括AMI（7.9%比5.6%,p=0.02）、卒中（8.8%比6.7%,p=0.01）和MACE（18.5%比16.3%,p=0.01）。然而，在Lp(a)队列中，死亡率（4.6% vs. 7.2%, p<0.01）和严重急性肢体事件（MALE）（3.2% vs. 5.6%, p<0.01）较低。在匹配的队列中，这些差异没有统计学意义。与Lp(a)未升高的患者相比，PAD和Lp(a)升高的患者LDL和Non-HDL胆固醇水平显著降低，表明该组的脂质控制更好。具体来说，LDL水平平均为79.6 mg/dL vs. 82.3 mg/dL (p = 0.025)，非hdl水平平均为103.2 mg/dL vs. 108.2 mg/dL (p = 0.005)，表明Lp(a)升高组的脂质谱更有利。结论与Lp(a)升高的spad患者相比，Lp(a)升高的spad患者在基线特征和结局上存在显著差异。然而，匹配后，大多数结果的差异被缓解，强调了Lp(a)作为PAD潜在风险标志物的重要性。尽管具有临床意义，但Lp(a)检测仍未得到充分利用，这凸显了在PAD患者中增加筛查的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of clinical lipidology 医学-药学

CiteScore

7.00

自引率

6.80%

发文量

209

审稿时长

49 days

期刊介绍： Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner. Sections of Journal of clinical lipidology will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.