Mechanisms
In 10,435 PCI patients, Lp(a)'s cardiovascular risk sharpens as kidney function worsens and nearly vanishes with normal kidneys (Clin Kidney J 2024)
Original title: Renal function alters the association of lipoprotein(a) with cardiovascular outcomes in patients undergoing percutaneous coronary intervention: a prospective cohort study
This prospective cohort study included 10,435 patients who underwent percutaneous coronary intervention (PCI) between January and December 2013, stratified into three groups by baseline estimated glomerular filtration rate (eGFR): below 60, 60-90, and 90 mL/min/1.73 m2 or above. Over a median 5.1-year follow-up, 2,144 major adverse cardiac and cerebrovascular events (MACCE) occurred. Both eGFR below 60 and elevated Lp(a) independently conferred higher MACCE risk after adjustment. Higher Lp(a) significantly predicted MACCE in patients with eGFR below 60, but this association weakened with only mild renal impairment and largely disappeared with normal renal function, a significant interaction between renal category and Lp(a) (P = 0.026). Patients with both Lp(a) at or above 30 mg/dL and eGFR below 60 had notably worse cardiovascular outcomes than those without both. Renal function mediates the strength of Lp(a)'s association with cardiovascular outcomes after PCI, with the risk concentrated in patients with impaired kidney function, supporting closer monitoring and more aggressive management in this subgroup.
Original abstract
Background And Hypothesis: Lipoprotein(a) [Lp(a)] and renal dysfunction are both independent risk factors for cardiovascular disease. However, it remains unclear whether renal function mediates the association between Lp(a) and cardiovascular outcomes in patients undergoing percutaneous coronary intervention (PCI).
Methods: From a large prospective cohort study, 10 435 eligible patients undergoing PCI from January 2013 to December 2013 were included in our analysis. Patients were stratified into three renal function groups according to their baseline estimated glomerular filtration rate (eGFR) (<60; 60-90; ≥90 ml/min/1.73 m2). The primary endpoint was a composite of all-cause death, nonfatal MI, ischemic stroke, and unplanned revascularization [major adverse cardiac and cerebrovascular events (MACCE)].
Results: Over a median follow-up of 5.1 years, a total of 2144 MACCE events occurred. After multivariable adjustment, either eGFR <60 ml/min/1.73 m2 or elevated Lp(a) conferred a significantly higher MACCE risk. Higher Lp(a) was significantly associated with an increased risk of MACCE in patients with eGFR <60 ml/min/1.73 m2. However, this association was weakened in subjects with only mild renal impairment and diminished in those with normal renal function. A significant interaction for MACCE between renal categories and Lp(a) was observed (P = 0.026). Patients with concomitant Lp(a) ≥30 mg/dl and eGFR <60 ml/min/1.73 m2 experienced worse cardiovascular outcomes compared with those without.
Conclusion: The significant association between Lp(a) and cardiovascular outcomes was mediated by renal function in patients undergoing PCI. Lp(a)-associated risk was more pronounced in patients with worse renal function, suggesting close monitoring and aggressive management are needed in this population.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.