Study on Serum Lipoprotein(a) and ASCVD Risk in Chinese MHD Patients

In a study, researchers found that elevated serum lipoprotein(a) (Lp(a)) was associated with an increased risk of atherosclerotic cardiovascular disease in Chinese maintenance hemodialysis patients. A study on this was published recently in BMC Nephrology by Qiaojing Liang and colleagues. The study at Beijing Tongren Hospital brings into light serum Lp(a) as a clinical biomarker for assessing atherosclerotic cardiovascular disease (ASCVD) risk in this population.

Serum Lp(a) is an established independent risk factor for ASCVD in the general population, but its role in ASCVD incidence among Chinese MHD patients was less clear. The present study aimed to clarify the relationship of Lp(a) levels with ASCVD events in a cohort of MHD patients from Beijing, China.

Study Design

This was a retrospective observational cohort study of MHD patients treated in Beijing Tongren Hospital between January 1, 2013, and December 1, 2020, with follow-up until December 1, 2023. Primary outcome: the occurrence of ASCVD events. We used Kaplan-Meier survival analysis to evaluate ASCVD-free survival rates according to Lp(a) level strata. Cox regression analyses assessed the relationship of Lp(a) level with ASCVD incidence.

Results

• There were a total of 265 patients, and the median follow-up period was 71 months.
• There were 78 (29.4%) ASCVD events and 118 (47%) deaths; 58 (49.1%) were attributed due to ASCVD.
• Spearman rank correlation tests have found correlations positively for serum Lp(a) and LDL-c levels whereas negative ones with hemoglobin, triglyceride, serum iron, serum creatinine, and albumin levels.

Conclusion

Using the multivariate Cox regression analysis, it was evidenced that Lp(a) level ≥30 mg/L, advanced age, low serum albumin, and diabetes mellitus were significantly associated with increased incidence of ASCVD.

In this regard, the results from the current study support the need for stratification of MHD patients using the measurement of serum Lp(a). The close relationship between high levels of Lp(a) and increased incidence of ASCVD suggests that, in fact, Lp(a) may stand as a good early marker for the identification of at-risk individuals. This becomes rather more important in the case of MHD, where cardiovascular complications are among the leading causes of death in such patients.

Practical Clinical Implications

The regular monitoring of serum Lp(a) could provide risk stratification and early intervention, hence improving outcomes in MHD patients. In view of already high mortality related to ASCVD in this population, adding screening for Lp(a) in routine practice can become an important addition to the algorithm of cardiovascular risk management.

This is, therefore, a positive evidence study associating elevated serum Lp(a) levels with an increased risk of ASCVD in MHD patients. The results gave an indication that serum Lp(a) levels could be useful clinical indicators in estimating ASCVD risk and thus require monitoring with early interventions in this vulnerable population.

Reference

Liang, Q., Zhang, G., & Jiang, L. (2024). Association between lipoprotein (a) and risk of atherosclerotic cardiovascular disease events among maintenance hemodialysis patients in Beijing, China: a single-center, retrospective study. BMC Nephrology, 25(1). https://doi.org/10.1186/s12882-024-03690-z