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Elevated Lp(a) confers risk for ischemic stroke but not AF
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High levels of lipoprotein(a) were associated with elevated ischemic stroke risk in patients without atrial fibrillation, according to new data from the ARIC cohort study.
However, Lp(a) levels were not associated with AF across the entire cohort, nor with ischemic stroke in individuals with AF, researchers reported.
Konstantinos N. Aronis, MD, from the division of cardiology at Johns Hopkins University School of Medicine, and colleagues evaluated incident AF in 9,908 participants without AF at baseline, and incident ischemic stroke in 10,127 participants free from stroke at baseline to determine whether Lp(a) levels were associated with either.
Mean age at baseline was 63 years, median Lp(a) levels were 13.3 mg/dL (interquartile range, 5.2-39.7) and median follow-up was 13.9 years for AF and 15.8 years for stroke.
Aronis and colleagues found that when those with Lp(a) 50 mg/dL were compared with those with Lp(a) < 10 mg/dL, Lp(a) levels had no association with incident AF during the study period (HR = 0.98; 95% CI, 0.82-1.17).
In individuals without AF, elevated Lp(a) was associated with increased stroke risk (HR = 1.42; 95% CI, 1.07-1.9), but the same was not true for people with AF (HR = 1.06; 95% CI, 0.7-1.61; P for interaction for AF = .25), according to the researchers.
Results did not differ by race or sex, and no association was found between Lp(a) levels and cardioembolic stroke risk.
“Elevated Lp(a) is primarily associated with diseases directly related to atherosclerosis and is not a risk factor for AF,” Aronis and colleagues wrote. “We did not find an association of Lp(a) with cardioembolic stroke, suggesting that the association of Lp(a) with ischemic stroke was primarily driven by thrombotic (atherosclerotic) stroke. It remains unknown whether extremely elevated Lp(a) levels could be associated with AF. Whether reductions of Lp(a) levels by lifestyle modifications or with medical therapy (currently being evaluated) results in reduction of stroke risk remains to be determined.” – by Erik Swain
Disclosure: Aronis reports no relevant financial disclosures. Please see the study for a list of the other authors’ relevant financial disclosures.
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