Lipoprotein(a) Levels and Adverse Outcomes in Heart Failure.

Background: Although lipoprotein(a) [Lp(a)] level elevation is associated with new-onset heart failure (HF), it is unclear if elevated Lp(a) levels predict cardiovascular events in patients with chronic HF. Thus, we examined the association between Lp(a) levels and adverse cardiovascular outcomes in patients with HF.

Methods and results: A total of 1088 patients with HF undergoing cardiac catheterization at Emory-affiliated hospitals from 2004 to 2022 were divided into low (<30 mg/dL), intermediate (30-49 mg/dL), and high (≥50 mg/dL) Lp(a) groups. The primary outcome was the composite of cardiovascular death and HF hospitalization. Outcomes were assessed by Lp(a) group with competing risk modeling accounting for noncardiovascular death after adjustment for demographics, traditional cardiovascular risk factors, ejection fraction, ischemic HF etiology, and N-terminal prohormone of brain natriuretic peptide. Sensitivity analyses were performed to explore for heterogeneity of effect. The median age was 67 years, 34% were women, 18% were Black, 74% had ischemic HF, and 60% had an ejection fraction of ≤40%. During a median follow-up time of 4.3 years, 474 composite events (44%) occurred. When compared with participants with Lp(a) <30 mg/dL after multivariable adjustment, those with Lp(a) 30-49 mg/dL (subdistribution hazard ratio [sHR] 1.35, 95% confidence interval 1.04-1.76, P = .025) and Lp(a) ≥50 mg/dL (sHR 1.38, 95% confidence interval 1.11-1.72, P = .004) had a significantly higher risk of cardiovascular death or HF hospitalization. This relationship seemed to diminish over time and was nominally stronger in those with ischemic versus nonischemic HF (P_interaction = .06), but did not meet significance after adjustment for multiple hypothesis testing.

Conclusions: In patients with HF, Lp(a) ≥30 mg/dL independently predicts the risk of cardiovascular death or HF hospitalization.