OBJECTIVES: The study aims to explore the effect of elevated Lp(a) concentrations on ASCVD prognosis, healthcare resource utilization (HCRU) and medical costs in Chinese ASCVD patients.

METHODS: Clinical data of 10,655 patients diagnosed with ASCVD for the first time were obtained from an electronic medical database from 2016 to 2020. The risk of major adverse cardiovascular events (MACEs: emergency coronary artery revascularization, myocardial infarction, stroke, heart failure, and CV death) was compared between patients with baseline Lp(a) ≥30 mg/dL and Lp(a) <30 mg/dL using adjusted multivariate Cox-regression models. Covariates with missing data were imputed by multiple imputation (MI). Propensity score matching (PSM) or inverse probability treatment weighting (IPTW) was used to doubly balance the baseline confounders. HCRU and costs were assessed one year after ASCVD diagnosis based on Lp(a) concentrations, with t-test and linear regression used for statistical analysis.

RESULTS: Incidence of MACEs was 147.7 per 1,000 person-years after the first diagnosis of ASCVD. Compared to Lp(a) <30 mg/dL, Lp(a) ≥30 mg/dL had increased risk of MACEs. Hazard ratio was 1.171 (95%CI: 1.010-1.358) by the covariate-adjusted Cox model without MI, PSM or IPTW; 1.118 (95%CI: 0.981-1.274) with MI; 1.112 (95%CI: 0.947-1.307) with MI and PSM; and 1.124 (95%CI: 0.984-1.284) with MI and IPTW. Total one-year medical fee (CNY) for Lp(a) ≥30mg/dL patients was higher than Lp(a) <30mg/dL ( 31,193 ± 63,397 vs. 26,621 ± 35,965; P =0.008). Total one-year hospitalizations (frequency) of Lp(a) ≥30mg/dL patients were more than Lp(a) <30mg/dL (0.833 ± 1.184 vs. 0.705 ± 1.037; P <0.0001). Continuous increase in Lp(a) concentrations is also associated with an increase in hospitalizations (P <0.0001) and total medical costs (P <0.0001).

CONCLUSIONS: Higher Lp(a) is associated with greater MACEs risk, more HCRU, and higher medical costs. Lp(a) lowering is beneficial for Chinese ASCVD patients in a secondary prevention setting.