High Level of Lipoprotein(a) as Predictor for Recurrent Heart Failure in Patients with Chronic Heart Failure: a Cohort Study

Abstract Background: Elevated plasma levels of Lipoprotein(a) [Lp(a)] are recognized as a significant risk factor for atherosclerotic vascular disease. However, there are limited data regarding association between Lp(a) and recurrent heart failure (HF) in patients with chronic HF caused by coronary heart disease (CHD). Objective: Elevated levels of Lp(a) might have a prognostic impact on recurrent HF in patients with chronic HF caused by CHD. Methods: A total of 309 patients with chronic HF caused by CHD were consecutively enrolled in this study. The patients were divided into 2 groups according to whether Lp(a) levels were above or below the median level for the entire cohort (20.6 mg/dL): the high Lp(a) group (n = 155) and the low Lp(a) group (n = 154). A 2-sided p < 0.05 was statistically considered significant. Results: During the median follow-up period of 186 days, 31 cases out of a total of 309 patients (10.03%) could not be reached during follow-up. A Kaplan-Meier analysis demonstrated that patients with higher Lp(a) levels had a higher incidence of recurrent HF than those with lower Lp(a) levels (log-rank < 0.0001). A multivariate Cox regression analysis revealed that Lp(a) levels were independently correlated with the incidence of recurrent HF after adjustment of potential confounders (hazard ratio: 2.720, 95 % confidence interval: 1.730-4.277, p < 0.0001). Conclusions: In Chinese patients with chronic HF caused by CHD, elevated levels of Lp(a) are independently associated with recurrent HF.

### 背景
血浆脂蛋白(a) [Lipoprotein(a), Lp(a)]水平升高，已被公认为动脉粥样硬化性血管疾病的重要危险因素。然而，目前针对冠心病（Coronary Heart Disease, CHD）所致慢性心力衰竭（Heart Failure, HF）患者中，Lp(a)与复发性心力衰竭之间关联的相关研究数据较为匮乏。

### 研究目的
探讨Lp(a)水平升高对冠心病所致慢性心力衰竭患者复发性心力衰竭的预后影响。

### 研究方法
本研究连续纳入309例冠心病所致慢性心力衰竭患者。以全体研究队列的Lp(a)中位水平（20.6 mg/dL）为界值，将患者分为高Lp(a)组（n=155）与低Lp(a)组（n=154）。采用双侧检验，以P<0.05作为统计学显著性判定标准。

### 研究结果
中位随访时长为186天，共计309例患者中有31例（10.03%）在随访期间失访。Kaplan-Meier分析结果显示，Lp(a)水平较高的患者复发性心力衰竭发生率显著高于Lp(a)水平较低的患者（log-rank检验P<0.0001）。多因素Cox回归分析显示，在校正潜在混杂因素后，Lp(a)水平仍与复发性心力衰竭的发生独立相关（风险比（Hazard Ratio, HR）：2.720，95%置信区间（Confidence Interval, CI）：1.730~4.277，P<0.0001）。

### 研究结论
在冠心病所致慢性心力衰竭的中国患者中，Lp(a)水平升高与复发性心力衰竭存在独立相关性。