Relationship between plasma Lipoprotein(a)and acute myocardial infarction risk in patients with severe renal disease:A restricted cubic spline analysis

GUO Li-juan; YUAN Yu-ting; SUN Xing-he; ZHANG Xian; YANG Quan; LIU Xiao-hui

doi:10.3969/j.issn.1672-5301.2026.02.004

Abstract：Objective To investigate the relationship between plasma lipoprotein(a)[Lp(a)]levels and the risk of acute myocardial infarction(AMI)in patients with severe renal disease[estimated glomerular filtration rate(eGFR)<30 ml·min-1·1.73m-2],as well as to evaluate the predictive value of plasma Lp(a)levels for AMI risk.Methods This study included 136 patients with coronary heart disease and severe renal disease who were admitted to the Cardiology Department of Peking University International Hospital between July 2018 and March 2023.Among these,43 patients were diagnosed with AMI and formed the study group(AMI group),while 93 patients without AMI constituted the control group(non-AMI group).High Lp(a)was defined as plasma Lp(a)>300 mg/L.Logistic regression analysis models and restricted cubic spline(RCS)model were used to assess the relationship between high Lp(a)(or quartiles of plasma Lp(a)levels)and AMI risk.Additionally,the receiver operating characteristic(ROC)curve analysis was performed to determine the predictive capability of plasma Lp(a)levels for AMI,calculating the area under the curve(AUC)and the associated 95%confidence interval(CI).The optimal cutoff point,sensitivity,and specificity of plasma Lp(a)for predicting AMI in patients with severe renal disease were derived based on the Youden index.Results In patients with severe renal disease,no significant difference in plasma Lp(a)levels was observed between patients with CKD 4 and CKD 5(P>0.05).However,the proportion of high Lp(a)was significantly higher in the AMI group than in the non-AMI group[275.0(132.0,778.0)mg/L vs.103.0(58.0,196.0)mg/L,P<0.05].Multivariable Logistic regression analysis and trend tests indicated that,after adjusting for confounders,high Lp(a)(OR=3.95,95%CI 1.59-9.83,P<0.01)was an independent predictor of AMI in patients with severe renal disease.Moreover,the risk of AMI in the highest quartile(Q4)of Lp(a)was 6.36 times that of the lowest quartile(Q1).RCS analysis demonstrated a linear dose-response relationship between Lp(a)and AMI risk(Pnonlinearity>0.05).ROC curve analysis revealed an AUC of plasma Lp(a)levels in predicting AMI was 0.713(95%CI 0.615-0.810,P<0.01),with an optimal cutoff value of 145 mg/L,the sensitivity of 0.744 and the specificity of 0.624.Conclusions Elevated plasma Lp(a)levels significantly increase the risk of AMI,with a linear dose-response relationship observed.Plasma Lp(a)levels can serve as a valuable predictor of AMI risk in this patient population.