Waist to hip ratio modifies the cardiovascular risk of lipoprotein (a): Insights from MESA.

AIMS: To assess if adiposity measures such as waist-to-hip ratio (WHR) modify the relationship of lipoprotein (a) [Lp(a)] with atherosclerotic cardiovascular disease (ASCVD). METHODS: 4652 participants from the Multi-Ethnic Study of Atherosclerosis (MESA) were grouped as follows: Lp(a) < 50 mg/dl and WHR <90th percentile(pct) (reference); Lp(a) < 50 mg/dl and WHR ≥90th pct; Lp(a) ≥ 50 mg/dl and WHR <90th pct; and Lp(a) ≥50 mg/dl and WHR ≥90th pct. Cox proportional hazard models assessed the relationship of Lp(a) and WHR with time to ASCVD events. RESULTS: Compared to the reference group, isolated elevated Lp(a) ≥ 50 mg/dl or WHR ≥90th pct were not significantly associated with risk of ASCVD (hazard ratio (HR), 1.15, 95 % confidence interval (CI): 0.94-1.39) and (HR, 1.14, 95 % CI: 0.92-1.41), respectively. In contrast, the combination of elevated Lp(a) ≥50 mg/dl and WHR ≥90th pct was associated with ASCVD risk (HR, 2.34, 95 % CI: 1.61-3.40). Lp(a) ≥50 mg/dl was not significantly associated with ASCVD risk in the 1st and 2nd tertile of WHR (HR, 1.06, 95 % CI: 0.72-1.48and HR, 1.08, 95 % CI: 0.79-1.48, respectively). However, Lp(a) ≥50 mg/dl was significantly associated with ASCVD risk in the highest tertile of WHR (HR, 1.60, 95 % CI: 1.23-2.09). (Interaction p = 0.01). Body mass index (BMI) and Lp(a) combinations resulted in similar greater risks of ASCVD in the highest risk category (HR, 1.33, 95 % CI: 1.00-1.77), without a significant interaction (p = 0.99). CONCLUSIONS: In MESA, WHR significantly modifies the risk of ASCVD associated with Lp(a). Measures of abdominal adiposity may further refine the cardiovascular risk in individuals with elevated Lp(a).

Duke Scholars

Author Neha Pagidipati Medicine, Cardiology