ABC | Volume 113, Nº2, August 2019

Original Article Yan et al. The effect of LP(a) on chronic heart failure Arq Bras Cardiol. 2019; 113(2):197-204 Table 3 – Associations between baseline Lp(a) with recurrent heart failure Exposure Non-adjusted HR (95%Cl) p value Adjust I HR (95%Cl) p value Adjust II HR (95%Cl) p value LP(a) 1.022 (1.016-1.028) < 0.0001 1.014 (1.006-1.023) 0.0008 1.018 (1.009-1.027) 0.0001 LP(a) < 20.6 1.0 1.0 1.0 ≥ 20.6 3.071 (2.283-4.130) < 0.0001 2.244 (1.493-3.371) 0.0001 2.720 (1.730-4.277) < 0.0001 AF: atrial fibrillation;ACEI: angiotensin-converting enzyme inhibitor;ARB: angiotensin II receptor blocker; BMI: bodymass index; DM: diabetesmellitus; eGFR: estimated glomerular filtration rate; HDL-C: high-density lipoprotein cholesterol; LVEF: left ventricular ejection fraction; LDL-C: low-density lipoprotein cholesterol; LAD: lesion left anterior descending artery lesion; Lp(a): lipoprotein(a); NYHA class: New York Heart Association class; NT-proBNP: N-terminal pro-B type natriuretic peptide; Prior PCI: prior percutaneous coronary intervention; SBP: systolic blood pressure; TC: total cholesterol; TG: triglycerides. Non-adjusted model adjust for: none. Adjust I model adjust for: number of stent, multiple lesions, aldosterone antagonists, LN-NT-proBNP, SBP, NYHA class. included subjects had lower glomerular filtration rate, which led to reduced clearance of Lp(a), and higher plasma levels than in other previously studied Chinese populations. In our study, the rates of statin use were up to 97.4% and 98.7% in patients with low-Lp(a) group and high-Lp(a) group, respectively, and most patients adhered to statin therapy during follow-up, but statins were originally intended to lower LDL-C levels. Moreover, previous studies have shown that statin therapy did not easily alter Lp(a) levels. 27,28 About the Lp(a) reduction treatment, early treatment with nicotinic acid, with the increase in nicotinic acid treatment dose, also correspondingly resulted in lower serum levels of Lp(a), and a maximum reduction in Lp(a) levels of up to30-40%. 29 Because of the significant side effects such as facial blushing and liver toxicity, it is no longer widely used. 30 Recently, newLp(a)‑lowering treatments have emerged. The novel lipid‑lowering drugMipomersen is a synthetic inhibitor of apoB that indirectly reduces the synthesis of Lp(a) by reducing the synthesis of apo B, which can significantly reduce Lp(a) levels in patients withCHD. 31 Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors reduce the level of LP(a) by inhibiting the degradation of low-density lipoprotein receptors (LDLR). 32 In the present study, none of the subjects used the abovementioned drugs. For patients with chronic HF due to CHD, further multicenter prospective randomized controlled trials are needed to verifywhether lowering the levels of serum Lp(a) can reduce the risk of cardiovascular and cerebrovascular events. Conclusion In conclusion, in Chinese patients with chronic HF caused by CHD, our study demonstrates that elevated levels of Lp(a) significantly predict recurrent HF. Limitations Our study has several limitations. First, it was a retrospective, observational and single-center study with selection bias. Therefore, whether the associations between LPA, B and HF are actually established, further multicenter prospective randomized controlled trials are needed to verify them in the future. Second, although we adjusted several known confounding variables in the multivariable Cox proportional hazards models, other unknown factors might have played roles in recurrent HF. Third, the detection of events may have been incomplete due to follow-up failures. 31 cases out of a total of 309 patients (10.03%) could not be reached during follow-up. Fourth, our study did not differ between HF with preserved and reduced ejection fraction when assessing the association between Lp(a) and recurrent HF in patients with chronic HF who have CHD. Author contributions Conception and design of the research: Yan J, Pan Y, Xiao J; Acquisition of data: Yan J, Pan Y; Analysis and interpretation of the data: Yan J, Pan Y, Xiao J, Zhong M, Long H; Statistical analysis: Yan J, Pan Y, Xiao J, Ma W, Li L, Zhong M, Long H, Kong F; Writing of the manuscript: Yan J, Pan Y, Shao W; Critical revision of the manuscript for intellectual content: Yan J, Pan Y, Ma W, Li L, Kong F, Shao W. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. Ethics approval and consent to participate This study was approved by the Ethics Committee of the The First Affiliated Hospital of Jinan University under the protocol number 017. All the procedures in this study were in accordance with the 1975 Helsinki Declaration, updated in 2013. Informed consent was obtained from all participants included in the study. 202