Lipoprotein(a) and Peripheral Artery Disease as Independent Predictors of Arterial Stiffness in Patients With Hypertension: A Single‐Center Cross‐Sectional Study

Carotid-femoral pulse-wave velocity (cfPWV) is a marker of central arterial stiffness and an established predictor of cardiovascular risk in hypertension. Although elevated lipoprotein(a) [Lp(a)] concentrations and peripheral arterial disease (PAD) are associated with atherosclerotic cardiovascular disease, their independent associations with central arterial stiffness and any potential interaction remain incompletely defined. We conducted a cross-sectional study of 366 adults with treated hypertension. Central arterial stiffness was assessed using cfPWV. Plasma Lp(a) concentrations were categorized into tertiles. PAD was identified using clinical history, physical examination, and available diagnostic investigations. Associations of Lp(a) tertiles and PAD with cfPWV were examined using robust linear regression. Multivariable models adjusted for covariates associated with cfPWV in univariable analyses, and interaction terms were used to assess effect modification by PAD. Mean cfPWV increased across ascending Lp(a) tertiles. After multivariable adjustment, cfPWV was higher by 0.82 m/s (95% confidence interval [CI], 0.31-1.32; p = 0.002) in the middle tertile and by 1.29 m/s (95% CI, 0.75-1.84; p < 0.001) in the highest tertile compared with the lowest tertile. PAD was independently associated with higher cfPWV (adjusted difference, 1.20 m/s; 95% CI, 0.78-1.62; p < 0.001). No interaction between Lp(a) tertiles and PAD was observed (p for interaction >0.10). In adults with treated hypertension, elevated Lp(a) concentrations and PAD were independently associated with greater central arterial stiffness, with no evidence of effect modification by PAD.