title: Cardiovascular Disease, Mortality Risk, and Healthcare Costs by Lipoprotein(a) Levels According to Low-density Lipoprotein Cholesterol Levels in Older High-risk Adults.
abstract: BACKGROUND
  The value of lipoprotein(a) (Lp[a]) for predicting cardiovascular disease (CVD) across low-density lipoprotein cholesterol (LDL-C) is uncertain.
  
  
  OBJECTIVE
  In older high-risk adults, higher LDL and Lp(a) combined would be associated with higher CVD risk and more healthcare costs.
  
  
  METHODS
  We included 3251 high-risk subjects (prior CVD, diabetes, or 10-year Framingham CVD risk >20%) age ≥65 years from the Cardiovascular Health Study and examined the relation of Lp(a) tertiles with incident CVD, coronary heart disease (CHD), and all-cause mortality within LDL-C strata (spanning <70 mg/dL to ≥160 mg/dL). We also examined 1-year all-cause and CVD healthcare costs from Medicare claims.
  
  
  RESULTS
  Over a 22.5-year follow-up, higher Lp(a) levels predicted CVD and total mortality (both standardized hazard ratio [HR]: 1.06, P < 0.01), whereas higher LDL-C levels predicted higher CHD (standardized HR: 1.09, P < 0.01) but lower total mortality (standardized HR: 0.94, P < 0.001). Adjusted HRs in the highest (vs lowest) tertile of Lp(a) level were 1.95 (P = 0.06) for CVD events and 2.68 (P = 0.03) for CHD events when LDL-C was <70 mg/dL. One-year all-cause healthcare costs were increased for Lp(a) ($771 per SD of 56 µg/mL [P = 0.03], $1976 for Lp(a) 25-64 µg/mL vs <25 µg/mL [P = 0.02], and $1648 for Lp(a) ≥65 µg/mL vs <25 µg/mL [P = 0.054]) but not LDL-C.
  
  
  CONCLUSIONS
  In older high-risk adults, increased Lp(a) levels were associated with higher CVD risk, especially in those with LDL-C <70 mg/dL, and with higher healthcare costs.
authors.affiliation: Heart Disease Prevention Program, Division of Cardiology, University of California Irvine, Irvine, California.|Department of Epidemiology, School of Public Health, University of California, Los Angeles, California.
authors.forename: Yanglu
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Delaney
authors.affiliation: Global Health Economics, Amgen Inc., Thousand Oaks, California.
authors.forename: Ruben G W
authors.initials: RG
authors.lastname: Quek
authors.affiliation: Department of Medicine, Hackensack University Medical Center, Hackensack, New Jersey.
authors.forename: Julius M
authors.initials: JM
authors.lastname: Gardin
authors.affiliation: Department of Medicine, University of California Davis, Davis, California.
authors.forename: Calvin H
authors.initials: CH
authors.lastname: Hirsch
authors.affiliation: Global Health Economics, Amgen Inc., Thousand Oaks, California.
authors.forename: Shravanthi R
authors.initials: SR
authors.lastname: Gandra
authors.affiliation: Heart Disease Prevention Program, Division of Cardiology, University of California Irvine, Irvine, California.
authors.forename: Nathan D
authors.initials: ND
authors.lastname: Wong
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000191:economics* / Q000401:mortality; D008078:Cholesterol, LDL / Q000097:blood*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D017270:Lipoprotein(a) / Q000097:blood*; D008297:Male; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL; D017270:Lipoprotein(a)