Clinical Report: Association of Lipoprotein(a) Levels with Treated Ventricular Arrhythmia Risk
Overview
This study evaluates the association between elevated lipoprotein(a) (Lp(a)) levels and the risk of treated ventricular arrhythmias in heart failure patients undergoing ICD implantation. Elevated Lp(a) was found to significantly increase the risk of appropriate ICD shocks.
Background
Lipoprotein(a) [Lp(a)] is a genetically determined risk factor linked to atherosclerotic cardiovascular disease and adverse myocardial remodeling. Its role in heart failure, particularly in identifying patients at risk for ventricular arrhythmias, remains unclear.
Data Highlights
Characteristic
Elevated Lp(a) (≥50 mg/dL)
Lower Lp(a) (<50 mg/dL)
Patients
190
405
ICD shocks
49 (25.8%)
39 (9.6%)
All-cause mortality
Not significantly different
Not significantly different
Key Findings
Elevated Lp(a) was associated with a higher incidence of appropriate ICD shocks (unadjusted HR 3.10; P < .001).
The adjusted hazard ratio for appropriate shocks in patients with elevated Lp(a) was 2.95 (P < .001).
For the composite outcome of appropriate shock or ATP, events occurred in 31.6% of patients with elevated Lp(a) compared to 15.3% with lower levels (aHR 2.37; P < .001).
All-cause mortality did not significantly differ between groups (aHR 0.80; P = .15).
No interaction was observed by ischemic vs nonischemic cardiomyopathy.
Clinical Implications
Clinicians should consider measuring Lp(a) levels in heart failure patients, particularly those undergoing ICD implantation, as elevated levels may indicate a higher risk for treated ventricular arrhythmias. However, elevated Lp(a) does not appear to correlate with increased mortality, suggesting effective management of arrhythmias may mitigate this risk.
Conclusion
Elevated Lp(a) levels are associated with an increased risk of treated ventricular arrhythmias in heart failure patients.
by Ramzi Ibrahim, Luke Dreher, Hussein Abdul Nabi, Juan Maria Farina, Eiad Habib, Hoang Nhat Pham, Min Choon Tan, Hussein A. Noureldine, Sammudeen Ibrahim, Mayurkumar Bhakta, Kwan Lee, Dan Sorajja, Win-Kuang Shen, Luis R. Scott, Chadi Ayoub, Reza Arsanjani, Hicham Z. El Masry
