Association of Alkaline Phosphatase with Cardiovascular Disease in Patients with Dyslipidemia: A 6-Year Retrospective Study

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Abstract

Background and Aim: Serum alkaline phosphatase (ALP) activity has been associated with atherosclerotic cardiovascular disease (ASCVD). We aimed to investigate the association of ALP with ASCVD in patients with dyslipidemia. Methods: We conducted a retrospective cohort study including consecutive adults with dyslipidemia followed-up for ≥3 years (from 1999 to 2022) in the outpatient Lipid Clinic of Ioannina University General Hospital, Greece. The primary endpoint was the association between baseline ALP and incident ASCVD after adjusting for traditional risk factors (i.e., sex, age, hypertension, diabetes, smoking, and dyslipidemia), baseline ASCVD, and lipid-lowering treatment. ALP levels were stratified by tertiles as follows: low: <67 U/L, middle: 67–79 U/L, high: ≥79 U/L. Results: Overall, 1178 subjects were included; 44% were males, and their median age was 57 years (range: 49–65). During a 6-year median follow-up (interquartile range: IQR: 4–9), 78 new ASCVD events (6.6%) occurred. A statistically significant association between baseline ALP levels and incident ASCVD was demonstrated (Odds Ratio, OR: 6.99; 95% Confidence Interval, CI: 2.29–21.03, p = 0.001). Subjects in the highest ALP tertile had the highest odds for ASCVD when compared with those in the lowest tertile (OR: 2.35; 95% CI: 1.24–4.41, p = 0.008). Conclusions: The present study indicates an association between ALP and the development of ASCVD in patients with dyslipidemia, which underscores the potential of ALP as a predictive tool or a therapeutic target in the realm of ASCVD prevention within this population.

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    RESEARCH QUESTIONS

    This study attempts to answer the following research questions:

    • Is there an association between baseline serum alkaline phosphatase (ALP) levels and the development of atherosclerotic cardiovascular disease (ASCVD) in patients suffering from dyslipidemia?

    • How does the risk of developing ASCVD vary across different tertiles of baseline ALP levels after adjusting for traditional risk factors (such as sex, age, hypertension, diabetes, smoking status, dyslipidemia), baseline ASCVD, and lipid-lowering treatment?

    • Can baseline ALP levels serve as a predictive biomarker for the development of ASCVD in patients with dyslipidemia?

    • Is there any potential for ALP to serve as a …