Association of lipoprotein(a) with ASCVD risk in women by menopausal status: the UK Biobank

Title: Association of Lipoprotein(a) with ASCVD Risk in Women by Menopausal Status: the UK Biobank Author names: Mikaila P. Reyes1, Alexander C. Razavi2, Harpreet S. Bhatia3 Affiliations: 1University of California San Diego School of Medicine, San Diego, CA, USA; mpr006@health.ucsd.edu2Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA; alexander.c.razavi@emory.edu3Division of Cardiovascular Medicine, University of California San Diego, CA, USA; hsbhatia@health.ucsd.edu ABSTRACTIntroduction: Lipoprotein(a) [Lp(a)] is a predominantly genetically determined risk factor for atherosclerotic cardiovascular disease (ASCVD); however, menopause is one of the few conditions that can lead to an increase in Lp(a). We aimed to investigate whether menopause status modifies the association between Lp(a) and ASCVD risk.Methods: A total of 153,890 pre- and post-menopausal women free of prior ASCVD were studied using data from the UK Biobank. Menopause status was based on self-report while ASCVD was a composite outcome based on ICD10-coded myocardial infarction, stroke or cardiovascular death. Multivariable Cox proportional hazards models evaluated the association between Lp(a) and incident ASCVD events stratified by menopause status.Results: The median age was 56.1 years, with 60% of women post-menopausal. Median Lp(a) was 22.5 [10.1, 62.1] nmol/L, 21% had Lp(a) >75 nmol/L, and 12% had Lp(a) ≥125 nmol/L. There were 5,160 (3.4%) incident ASCVD events during a median follow up of 13.7 years. Standard deviation increases in Lp(a) were associated with higher risk of ASCVD events among pre-menopausal (HR 1.06, 95% CI 1.00-1.12, p = 0.041) and post-menopausal women (HR 1.06, 95% CI 1.03 - 1.09, p 125 nmol/L (HR 1.15, 95% CI 1.05, 1.26, p = 0.003) were associated with increased ASCVD risk when compared to Lp(a) < 75 nmol/L. The association between Lp(a) and ASCVD risk did not vary with menopause status (p-interactions >0.05).Conclusion: Lp(a) is an independent risk factor for ASCVD events for both pre- and post-menopausal women.