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Association of Lipoprotein(a) Levels With Incidence of Major Adverse Limb Events
IMPORTANCE: High lipoprotein(a) (Lp[a]) levels are involved in the development of cardiovascular events, particularly in myocardial infarction, stroke, and peripheral artery disease. Studies assessing the Lp(a) levels associated with adverse lower-limb events are lacking. OBJECTIVE: To assess the as...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Medical Association
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9856359/ https://www.ncbi.nlm.nih.gov/pubmed/36480201 http://dx.doi.org/10.1001/jamanetworkopen.2022.45720 |
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author | Guédon, Alexis F. De Freminville, Jean-Baptiste Mirault, Tristan Mohamedi, Nassim Rance, Bastien Fournier, Natalie Paul, Jean-Louis Messas, Emmanuel Goudot, Guillaume |
author_facet | Guédon, Alexis F. De Freminville, Jean-Baptiste Mirault, Tristan Mohamedi, Nassim Rance, Bastien Fournier, Natalie Paul, Jean-Louis Messas, Emmanuel Goudot, Guillaume |
author_sort | Guédon, Alexis F. |
collection | PubMed |
description | IMPORTANCE: High lipoprotein(a) (Lp[a]) levels are involved in the development of cardiovascular events, particularly in myocardial infarction, stroke, and peripheral artery disease. Studies assessing the Lp(a) levels associated with adverse lower-limb events are lacking. OBJECTIVE: To assess the association between Lp(a) levels and incidence of major adverse limb events in unselected hospitalized patients. DESIGN, SETTING, AND PARTICIPANTS: This large retrospective monocentric cohort study was conducted from January 1, 2000, to December 31, 2020. Data were derived from the clinical information system of the Hôpital Européen Georges-Pompidou, a Paris-based university hospital. Patients who underwent at least 1 Lp(a) measurement at the center during the study period were included. Patients who had no follow-up data or who had the first Lp(a) measurement after the study outcome had occurred were excluded. Data analyses were performed from May 2021 to January 2022. MAIN OUTCOMES AND MEASURES: The primary outcome was the first inpatient major adverse limb event, defined as a major amputation, peripheral endovascular revascularization, or peripheral surgical revascularization, during follow-up. Secondary outcomes included individual components of the primary outcome. Lipoprotein(a) levels were categorized as follows: normal (<50 mg/dL), high (50 to <134 mg/dL), and very high (≥134 mg/dL); to convert Lp(a) values to milligrams per liter, multiply by 0.1. RESULTS: A total of 16 513 patients (median [IQR] age, 58.2 [49.0-66.7] years; 9774 men [59.2%]) were included in the cohort. The median (IQR) Lp(a) level was 24 (10.0-60.0) mg/dL. The 1-year incidence of major adverse limb event was 2.44% in the overall population and 4.54% among patients with very high Lp(a) levels. High (adjusted accelerated failure time [AFT] exponential estimate: 0.43; 95% CI, 0.24-0.78; Benjamini-Hochberg–corrected P = .01) and very high (adjusted AFT exponential estimate: 0.17; 95% CI, 0.07-0.40; Benjamini-Hochberg–corrected P < .001) Lp(a) levels were independently associated with an increased risk of major adverse limb event. CONCLUSIONS AND RELEVANCE: Results of this study showed that higher Lp(a) levels were independently associated with an increased risk of a major adverse limb event in hospitalized patients. The Lp(a) measurement needs to be taken into account to improve lower-limb vascular risk assessment. |
format | Online Article Text |
id | pubmed-9856359 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | American Medical Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-98563592023-02-03 Association of Lipoprotein(a) Levels With Incidence of Major Adverse Limb Events Guédon, Alexis F. De Freminville, Jean-Baptiste Mirault, Tristan Mohamedi, Nassim Rance, Bastien Fournier, Natalie Paul, Jean-Louis Messas, Emmanuel Goudot, Guillaume JAMA Netw Open Original Investigation IMPORTANCE: High lipoprotein(a) (Lp[a]) levels are involved in the development of cardiovascular events, particularly in myocardial infarction, stroke, and peripheral artery disease. Studies assessing the Lp(a) levels associated with adverse lower-limb events are lacking. OBJECTIVE: To assess the association between Lp(a) levels and incidence of major adverse limb events in unselected hospitalized patients. DESIGN, SETTING, AND PARTICIPANTS: This large retrospective monocentric cohort study was conducted from January 1, 2000, to December 31, 2020. Data were derived from the clinical information system of the Hôpital Européen Georges-Pompidou, a Paris-based university hospital. Patients who underwent at least 1 Lp(a) measurement at the center during the study period were included. Patients who had no follow-up data or who had the first Lp(a) measurement after the study outcome had occurred were excluded. Data analyses were performed from May 2021 to January 2022. MAIN OUTCOMES AND MEASURES: The primary outcome was the first inpatient major adverse limb event, defined as a major amputation, peripheral endovascular revascularization, or peripheral surgical revascularization, during follow-up. Secondary outcomes included individual components of the primary outcome. Lipoprotein(a) levels were categorized as follows: normal (<50 mg/dL), high (50 to <134 mg/dL), and very high (≥134 mg/dL); to convert Lp(a) values to milligrams per liter, multiply by 0.1. RESULTS: A total of 16 513 patients (median [IQR] age, 58.2 [49.0-66.7] years; 9774 men [59.2%]) were included in the cohort. The median (IQR) Lp(a) level was 24 (10.0-60.0) mg/dL. The 1-year incidence of major adverse limb event was 2.44% in the overall population and 4.54% among patients with very high Lp(a) levels. High (adjusted accelerated failure time [AFT] exponential estimate: 0.43; 95% CI, 0.24-0.78; Benjamini-Hochberg–corrected P = .01) and very high (adjusted AFT exponential estimate: 0.17; 95% CI, 0.07-0.40; Benjamini-Hochberg–corrected P < .001) Lp(a) levels were independently associated with an increased risk of major adverse limb event. CONCLUSIONS AND RELEVANCE: Results of this study showed that higher Lp(a) levels were independently associated with an increased risk of a major adverse limb event in hospitalized patients. The Lp(a) measurement needs to be taken into account to improve lower-limb vascular risk assessment. American Medical Association 2022-12-08 /pmc/articles/PMC9856359/ /pubmed/36480201 http://dx.doi.org/10.1001/jamanetworkopen.2022.45720 Text en Copyright 2022 Guédon AF et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License. |
spellingShingle | Original Investigation Guédon, Alexis F. De Freminville, Jean-Baptiste Mirault, Tristan Mohamedi, Nassim Rance, Bastien Fournier, Natalie Paul, Jean-Louis Messas, Emmanuel Goudot, Guillaume Association of Lipoprotein(a) Levels With Incidence of Major Adverse Limb Events |
title | Association of Lipoprotein(a) Levels With Incidence of Major Adverse Limb Events |
title_full | Association of Lipoprotein(a) Levels With Incidence of Major Adverse Limb Events |
title_fullStr | Association of Lipoprotein(a) Levels With Incidence of Major Adverse Limb Events |
title_full_unstemmed | Association of Lipoprotein(a) Levels With Incidence of Major Adverse Limb Events |
title_short | Association of Lipoprotein(a) Levels With Incidence of Major Adverse Limb Events |
title_sort | association of lipoprotein(a) levels with incidence of major adverse limb events |
topic | Original Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9856359/ https://www.ncbi.nlm.nih.gov/pubmed/36480201 http://dx.doi.org/10.1001/jamanetworkopen.2022.45720 |
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