Mechanisms
CASABLANCA study finds Lp(a) above 150 nmol/L nearly doubles the risk of stage A/B heart failure progressing to symptomatic disease (J Am Heart Assoc 2024)
Original title: Lipoprotein(a), Oxidized Phospholipids, and Progression to Symptomatic Heart Failure: The CASABLANCA Study
In the CASABLANCA study, 714 individuals referred for coronary angiography and classified as stage A/B heart failure (at risk or with structural disease but no symptoms) were followed for an average 3.7 years, during which 105 (14.7%) progressed to symptomatic stage C/D heart failure and 57 (8.0%) had cardiovascular death. After adjusting for heart failure risk factors including coronary disease and aortic stenosis, Lp(a) at or above 150 nmol/L predicted progression to symptomatic heart failure (hazard ratio 1.90, 95% CI 1.15-3.13, P = 0.01) and heart failure or cardiovascular death (hazard ratio 1.71, 95% CI 1.10-2.67, P = 0.02). Elevated oxidized phospholipids showed a similar association, especially combined with high Lp(a), and Kaplan-Meier analysis confirmed shorter time to progression with elevated Lp(a) (log-rank P < 0.001). In early-stage heart failure, higher Lp(a) and oxidized phospholipids independently predict progression to symptomatic disease or cardiovascular death.
Original abstract
Background: Higher lipoprotein(a) and oxidized phospholipid concentrations are associated with increased risk for coronary artery disease and valvular heart disease. The role of lipoprotein(a) or oxidized phospholipid as a risk factor for incident heart failure (HF) or its complications remains uncertain.
Methods And Results: A total of 1251 individuals referred for coronary angiography in the Catheter Sampled Blood Archive in Cardiovascular Diseases (CASABLANCA) study were stratified on the basis of universal definition of HF stage; those in stage A/B (N=714) were followed up for an average 3.7 years for incident stage C/D HF or the composite of HF/cardiovascular death. During follow-up, 105 (14.7%) study participants in stage A/B progressed to symptomatic HF and 57 (8.0%) had cardiovascular death. In models adjusted for multiple HF risk factors, including severe coronary artery disease and aortic stenosis, individuals with lipoprotein(a) ≥150 nmol/L were at higher risk for progression to symptomatic HF (hazard ratio [HR], 1.90 [95% CI, 1.15-3.13]; P=0.01) or the composite of HF/cardiovascular death (HR, 1.71 [95% CI, 1.10-2.67]; P=0.02). These results remained significant after further adjustment of the model to include prior myocardial infarction (HF: HR, 1.89, P=0.01; HF/cardiovascular death: HR, 1.68, P=0.02). Elevated oxidized phospholipid concentrations were similarly associated with risk, particularly when added to higher lipoprotein(a). In Kaplan-Meier analyses, individuals with stage A/B HF and elevated lipoprotein(a) had shorter time to progression to stage C/D HF or HF/cardiovascular death (both log-rank P<0.001).
Conclusions: Among individuals with stage A or B HF, higher lipoprotein(a) and oxidized phospholipid concentrations are independent risk factors for progression to symptomatic HF or cardiovascular death.
Registration: URL: https://wwwclinicaltrials.gov; Unique identifier: NCT00842868.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.