The joint association of lipoprotein(a) and lipoprotein-associated phopholipase A2 with the risk of stroke recurrence

Abstract

Background and purpose: Currently little is known about the joint association of lipoprotein (a) [Lp(a)] and lipoprotein-associated phospholipase A2 (Lp-PLA2) with stroke recurrence.

Methods: In this prospective multicenter cohort study, 10,675 consecutive acute ischemic stroke (IS) and transient ischemic attack (TIA) patients with Lp(a) and Lp-PLA2 were enrolled. The association of stroke recurrence within 1 year with Lp(a) and Lp-PLA2 was assessed using Cox proportional hazards models and Kaplan-Meier curves. The interaction between Lp(a) and Lp-PLA2 with stroke recurrence was evaluated by multiplicative and additive scales.

Results: A significant joint association of Lp(a) and Lp-PLA2 with the risk of stroke recurrence was observed. Multivariate Cox regression analysis demonstrated that the combination of elevated Lp(a) (≥ 50 mg/dL) and Lp-PLA2 (≥175.1 ng/mL) was independently associated with the risk of stroke recurrence (adjusted hazard ratio: 1.42; 95% confidence interval [CI]: 1.15-1.76). Both significant multiplicative [(exp(β3): 1.63, 95% CI: 1.17-2.29, P = 0.004] and additive interaction (RERI: 0.55, 95% CI: 0.20-0.90, P = 0.002; AP: 0.39, 95% CI, 0.24-0.53) were observed between Lp(a) and Lp-PLA2.

Conclusions: Our results indicated that Lp(a) and Lp-PLA2 have a joint association with the risk of stroke recurrence in IS/TIA patients. Patients with concomitant presence of elevated Lp(a) and Lp-PLA2 have greater risk of stroke recurrence.

Keywords: Lipoprotein(a); Lipoprotein-associated phospholipase A2; Residual risk; Stroke recurrence.