Lipoprotein(a) and Prognostic Nutritional Index Levels Exhibit Interactive and Joint Effects on Mortality Risk in Patients With Coronary Artery Disease: Findings From a Real-World Study
5 affiliations
- 1Department of Cardiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 510080 Guangzhou, Guangdong, China
- 2Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, 510080 Guangzhou, Guangdong, China
- 3Department of Cardiac Intensive Care Unit, The First People's Hospital of Kashi Prefecture, 844000 Kashi, Xinjiang, China
- 4Guangdong Provincial Geriatrics Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 510080 Guangzhou, Guangdong, China
- 5Global Health Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Science, Southern Medical University, 510080 Guangzhou, Guangdong, China
Abstract
Background:: Abnormal lipoprotein(a) (Lp(a)) levels and malnutrition are independent cardiovascular risk factors; however, the associated combined effects on mortality in patients with coronary artery disease (CAD) remain incompletely understood. Thus, this study aimed to evaluate the independent and joint associations of Lp(a) and the prognostic nutritional index (PNI) with all-cause and cardiovascular (CV) mortality in patients with CAD, as well as the associated combined interaction.
Methods:: A total of 47,482 patients with CAD from the Southern China multicenter Cardiorenal Improvement II cohort (2007–2020) were enrolled. Patients were stratified according to Lp(a) levels (low: <15 mg/dL; middle: 15 to <30 mg/dL; high: ≥30 mg/dL) and PNI (high: ≥45; low: <45). The primary outcomes were all-cause mortality and CV mortality. Restricted cubic splines were used to assess non-linear associations, while multivariable Cox models and Kaplan–Meier analyses were used for risk assessment; receiver operating characteristic (ROC) curves were used to compare predictive performance, and additive interaction analysis was used to evaluate joint effects.
Results:: During a median follow-up of 5.2 years, 5229 patients (11.01%) died from any cause and 3698 died from CV causes. In fully adjusted models, high Lp(a) combined with low PNI was associated with the highest risk of all-cause mortality (hazard ratio (HR) 1.85, 95% confidence interval (CI) 1.69–2.03) and CV mortality (HR 2.20, 95% CI 1.98–2.46), compared with the low Lp(a)/high PNI reference group. The combined model achieved a higher area under the receiver operating characteristic (AUROC) curve for mortality prediction than either marker alone (p < 0.05). Significant additive interactions between Lp(a) and PNI were observed for all-cause mortality (relative excess risk due to interaction, RERI 0.30, 95% CI 0.14–0.43) and CV mortality (RERI 0.32, 95% CI 0.11–0.52).
Conclusions:: Lp(a) and PNI are independently associated with increased long-term mortality in patients with CAD and demonstrate a significant additive interaction. Joint assessment of Lp(a) and PNI may help identify high-risk patients with CAD at hospital discharge and may inform clinical risk stratification, optimized management, and personalized follow-up.
Clinical Trial Registration:: NCT05050877, https://clinicaltrials.gov/study/NCT05050877?cond=NCT05050877&viewType=Card&rank=1.
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BibTeX
@article{chen2026lipoproteina,
title = {{Lipoprotein(a) and Prognostic Nutritional Index Levels Exhibit Interactive and Joint Effects on Mortality Risk in Patients With Coronary Artery Disease: Findings From a Real-World Study}},
author = {Jinming Chen and Xiaozhao Lu and Xianlin Ruan and Zeliang Li and Yimidiguli Aji and Ahmed Abdulwasea Furas Ali Mohsen and Wei Guo and Jiyan Chen and Shiqun Chen and Junyan Xu and Jin Liu and Yong Liu},
journal = {Reviews in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.31083/rcm51948},
url = {https://doi.org/10.31083/rcm51948},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Lipoprotein(a) and Prognostic Nutritional Index Levels Exhibit Interactive and Joint Effects on Mortality Risk in Patients With Coronary Artery Disease: Findings From a Real-World Study
AU - Jinming Chen
AU - Xiaozhao Lu
AU - Xianlin Ruan
AU - Zeliang Li
AU - Yimidiguli Aji
AU - Ahmed Abdulwasea Furas Ali Mohsen
AU - Wei Guo
AU - Jiyan Chen
AU - Shiqun Chen
AU - Junyan Xu
AU - Jin Liu
AU - Yong Liu
PY - 2026
DA - 2026/10/16
JO - Reviews in Cardiovascular Medicine
DO - 10.31083/rcm51948
UR - https://doi.org/10.31083/rcm51948
AB - Background:: Abnormal lipoprotein(a) (Lp(a)) levels and malnutrition are independent cardiovascular risk factors; however, the associated combined effects on mortality in patients with coronary artery disease (CAD) remain incompletely understood. Thus, this study aimed to evaluate the independent and joint associations of Lp(a) and the prognostic nutritional index (PNI) with all-cause and cardiovascular (CV) mortality in patients with CAD, as well as the associated combined interaction. Methods:: A total of 47,482 patients with CAD from the Southern China multicenter Cardiorenal Improvement II cohort (2007–2020) were enrolled. Patients were stratified according to Lp(a) levels (low: <15 mg/dL; middle: 15 to <30 mg/dL; high: ≥30 mg/dL) and PNI (high: ≥45; low: <45). The primary outcomes were all-cause mortality and CV mortality. Restricted cubic splines were used to assess non-linear associations, while multivariable Cox models and Kaplan–Meier analyses were used for risk assessment; receiver operating characteristic (ROC) curves were used to compare predictive performance, and additive interaction analysis was used to evaluate joint effects. Results:: During a median follow-up of 5.2 years, 5229 patients (11.01%) died from any cause and 3698 died from CV causes. In fully adjusted models, high Lp(a) combined with low PNI was associated with the highest risk of all-cause mortality (hazard ratio (HR) 1.85, 95% confidence interval (CI) 1.69–2.03) and CV mortality (HR 2.20, 95% CI 1.98–2.46), compared with the low Lp(a)/high PNI reference group. The combined model achieved a higher area under the receiver operating characteristic (AUROC) curve for mortality prediction than either marker alone (p < 0.05). Significant additive interactions between Lp(a) and PNI were observed for all-cause mortality (relative excess risk due to interaction, RERI 0.30, 95% CI 0.14–0.43) and CV mortality (RERI 0.32, 95% CI 0.11–0.52). Conclusions:: Lp(a) and PNI are independently associated with increased long-term mortality in patients with CAD and demonstrate a significant additive interaction. Joint assessment of Lp(a) and PNI may help identify high-risk patients with CAD at hospital discharge and may inform clinical risk stratification, optimized management, and personalized follow-up. Clinical Trial Registration:: NCT05050877, https://clinicaltrials.gov/study/NCT05050877?cond=NCT05050877&viewType=Card&rank=1.
SN - 1530-6550
SN - 2153-8174
ER -