{"title":"Phenomapping of subgroups in high-Lp(a) patients: a data-driven cluster analysis in RED-CARPET study.","authors":"Shaozhao Zhang, Xiaoyu Lin, Rongjian Zhan, Huimin Zhou, Yuhui Lai, Mengting Huang, Bingzhen Li, Xinxue Liao, Xiaodong Zhuang","doi":"10.1007/s00392-025-02669-6","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The association between high levels of lipoprotein (a) [Lp(a)] and cardiovascular disease (CVD) is influenced by clinical characteristics. We aimed to explore the heterogeneity in high Lp(a) population with different clinical phenotypes and their relationship with atherosclerosis cardiovascular disease (ASCVD) risk.</p><p><strong>Methods and results: </strong>We included 11,629 participants with Lp(a) measurement in RED-CARPET Study (ChiCTR2000039901) from the First Affiliated Hospital of Sun Yat-Sen University. The primary outcome was the occurrence of ASCVD events. The k-means clustering method was performed for baseline variables in participants with high Lp(a) levels (Lp(a) ≥ 50 mg/dL). Multivariate logistic regression model was used to assess the association between high Lp(a) level and ASCVD across clusters, with the low-Lp(a) group (Lp(a) < 50 mg/dL) serving as reference. Propensity score matching (PSM) was used to validate thefindings. High-Lp(a) group was categorized into four clusters: cluster 1 (dyslipidemia); cluster 2 (aged females); cluster 3 (males with an unhealthy lifestyle) and cluster 4 (anemia, renal insufficiency and hypercoagulability). Patients in different clusters exhibited differences in ASCVD risk. Patients with high-Lp(a) had significantly highest risk for ASCVD in cluster 3 (OR 2.12, 95% CI 1.62-2.76, p < 0.001) after adjusting for traditional risk factors. However, no significant association was observed in cluster 4 (OR 0.82, 95% CI 0.58-1.16, p = 0.233). These findings remained consistent after PSM.</p><p><strong>Conclusions: </strong>Using a data-driven approach, high-Lp(a) patients can be stratified into four phenotypically distinct subgroups with different ASCVD risk.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.8000,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Research in Cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00392-025-02669-6","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: The association between high levels of lipoprotein (a) [Lp(a)] and cardiovascular disease (CVD) is influenced by clinical characteristics. We aimed to explore the heterogeneity in high Lp(a) population with different clinical phenotypes and their relationship with atherosclerosis cardiovascular disease (ASCVD) risk.
Methods and results: We included 11,629 participants with Lp(a) measurement in RED-CARPET Study (ChiCTR2000039901) from the First Affiliated Hospital of Sun Yat-Sen University. The primary outcome was the occurrence of ASCVD events. The k-means clustering method was performed for baseline variables in participants with high Lp(a) levels (Lp(a) ≥ 50 mg/dL). Multivariate logistic regression model was used to assess the association between high Lp(a) level and ASCVD across clusters, with the low-Lp(a) group (Lp(a) < 50 mg/dL) serving as reference. Propensity score matching (PSM) was used to validate thefindings. High-Lp(a) group was categorized into four clusters: cluster 1 (dyslipidemia); cluster 2 (aged females); cluster 3 (males with an unhealthy lifestyle) and cluster 4 (anemia, renal insufficiency and hypercoagulability). Patients in different clusters exhibited differences in ASCVD risk. Patients with high-Lp(a) had significantly highest risk for ASCVD in cluster 3 (OR 2.12, 95% CI 1.62-2.76, p < 0.001) after adjusting for traditional risk factors. However, no significant association was observed in cluster 4 (OR 0.82, 95% CI 0.58-1.16, p = 0.233). These findings remained consistent after PSM.
Conclusions: Using a data-driven approach, high-Lp(a) patients can be stratified into four phenotypically distinct subgroups with different ASCVD risk.
期刊介绍:
Clinical Research in Cardiology is an international journal for clinical cardiovascular research. It provides a forum for original and review articles as well as critical perspective articles. Articles are only accepted if they meet stringent scientific standards and have undergone peer review. The journal regularly receives articles from the field of clinical cardiology, angiology, as well as heart and vascular surgery.
As the official journal of the German Cardiac Society, it gives a current and competent survey on the diagnosis and therapy of heart and vascular diseases.