Impact of hypertension on associations of all-cause mortality with admission lipoprotein (a) in acute decompensated heart failure

Abstract

Background and aims

Serum lipoprotein(a) [Lp(a)] is recognized as an independent risk factor for cardiovascular disease. However, whether hypertension modifies the association between Lp(a) and adverse outcomes in acute decompensated heart failure (ADHF) remains unclear. We investigated how hypertension status influences the relationship between Lp(a) and all-cause mortality in ADHF.

Methods

We conducted a single-center retrospective observational study including 2610 patients hospitalized with ADHF. We normalized the distribution of Lp(a) by a logarithmic transformation and assessed the risk of all-cause mortality with Lp(a), using Cox regression with adjustment for potential confounders.

Results

Among 2610 patients (39.0% women; mean age, 68.8 years), 1606 (61.5%) had hypertension. Over 4.1 years (median), 1287 deaths occurred. In all patients, log-transformed Lp(a) was significantly associated with mortality (adjusted HR 1.21; 95% CI, 1.05-1.39; P = 0.007), with the highest tertile showing increased risk compared to the lowest tertile (HR 1.19; 95% CI, 1.03-1.37; P = 0.016). In ADHF combined with hypertension, Lp(a) conferred higher risk of mortality (HR, 1.35; 95% CI, 1.13-1.62; P = 0.001); and the highest tertile of Lp(a) was associated with higher risk of mortality (HR, 1.33; 95% CI, 1.11-1.59; P = 0.002) compared with the lowest tertile. However, there were no associations between mortality and Lp(a) in those without hypertension (P ≥ 0.41). The interaction between hypertension with Lp(a) was significant for mortality (P = 0.002).

Conclusions

Increased admission Lp(a) levels were associated with a higher risk of all-cause mortality in ADHF patients with hypertension. Further studies are needed to explore the mechanistic links among Lp(a), hypertension and ADHF.