| Title: | Lipoprotein(a) elevation independently associates with incident atrial fibrillation irrespective of inflammatory status |
| Journal: | Heart Rhythm |
| Published: | 6 Aug 2025 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/40780691/ |
| DOI: | https://doi.org/10.1016/j.hrthm.2025.08.001 |
Publication 18720
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Abstract
BACKGROUND: Atrial fibrillation (AF) significantly increases stroke, heart failure, and mortality risk. Elevated lipoprotein(a) (Lp[a]) is implicated in AF pathogenesis, but its relationship with systemic inflammation (assessed by high-sensitivity C-reactive protein [hs-CRP]) remains unclear.</p>
OBJECTIVE: We investigated whether the Lp(a)-AF association is independent of baseline inflammatory status.</p>
METHODS: In this retrospective cohort study, we analyzed 365,899 United Kingdom (UK) Biobank participants without baseline AF. Lp(a) was modeled as a continuous exposure (per 50 nmol/L increase) and categorically (≥125 nmol/L). Systemic inflammation was defined as hs-CRP ≥2 mg/L. Multivariable Cox proportional hazards models (adjusted for age, sex, cardiovascular risk factors, and comorbidities) and Fine-Gray competing risk analyses estimated adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for incident AF.</p>
RESULTS: Over a median 13.5-year follow-up, 25,048 (6.8%) incident AF cases occurred. Elevated Lp(a) (7.44% vs 6.77%, log-rank P < .001) and hs-CRP (8.49% vs 5.96%, log-rank P < .001) were associated with higher incident AF. Cox proportional hazard model adjusted for covariates, higher Lp(a) (≥125 nmol/L) was associated with increased AF risk regardless of hs-CRP levels for AF (hs-CRP ≥2 mg/L: HR, 1.12; 95% CI, 1.06-1.19; P < .001; hs-CRP <2 mg/L: HR, 1.09; 95% CI, 1.04-1.15; P = .001). Results remained consistent in propensity score matched cohorts and sensitivity analyses.</p>
CONCLUSION: Lp(a) is an independent risk factor for AF, irrespective of baseline inflammatory status, as measured by hs-CRP.</p>
16 Keywords
- Aged
- Atrial Fibrillation
- Biomarkers
- C-Reactive Protein
- Female
- Follow-Up Studies
- Humans
- Incidence
- Inflammation
- Lipoprotein(a)
- Male
- Middle Aged
- Retrospective Studies
- Risk Assessment
- Risk Factors
- United Kingdom
15 Authors
- Le Li
- Sheng Su
- Zhicheng Hu
- Lingmin Wu
- Limin Liu
- Likun Zhou
- Xi Peng
- Mengtong Xu
- Tao Zhang
- Minghao Zhao
- Yulong Xiong
- Zhenhao Zhang
- Lihui Zheng
- Ligang Ding
- Yan Yao
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