Elevated Lp(a) Level Raises ASCVD Risk Regardless of Age, Sex, Race/Ethnicity: Daily Dose

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Last week, we reported on findings from a study published in the Journal of the American College of Cardiology that examined the relationship of lipoprotein(a) (Lp[a]) with atherosclerotic cardiovascular disease (ASCVD) outcomes in a large, pooled, multi-ethnic US cohort.

The study

The study included data on Lp(a) and ASCVD outcomes from 5 US prospective studies: MESA (Multi-Ethnic Study of Atherosclerosis), CARDIA (Coronary Artery Risk Development in Young Adults), JHS (Jackson Heart Study), FHS-OS (Framingham Heart Study-Offspring), and ARIC (Atherosclerosis Risk In Communities).

The investigators created a pooled cohort from the 5 prospective studies of 27 756 individuals aged 20 to 79 years (mean age 51.2 years) with a measure of Lp(a) and without preexisting ASCVD at the time of measurement. Of the population, 55% were women, 35.6% were Black, 4.7% Hispanic, and 2.5% Asian. Participants with diabetes comprised 7.6%.

Within each study cohort, researchers categorized Lp(a) by percentile: <50th (reference), 50th to <75th, 75th to <90th, and =/>90th. The primary ASCVD outcomes were nonfatal and fatal MI and stroke, revascularization, and CHD death that occurred following the examination in each study at which Lp(a) levels were determined.

The findings

Compared with persons with Lp(a) in the <50th percentile, those in the 50th to <75th, 75th to <90th, and =/> 90th percentiles had higher adjusted HRs for incident ASCVD of 1.06 (95% CI, 0.99-1.14), 1.18 (95% CI, 1.09-1.28), and 1.46 (95% CI, 1.33-1.59), respectively.

HRs for incident ASCVD were progressively higher with higher Lp(a) levels for both men and women and among all race and ethnicity groups, although results were not significant for Asian and Hispanic participants, given small sample sizes and number of events.

Investigators reported further finding no significant differences in the relationship of Lp(a) and ASCVD event risk between groups identified by sex (P_interaction =.66) and race or ethnicity (P_interaction = .43).

Authors' comment

"It is hoped these data will be helpful to better inform investigators on the feasibility and design of future clinical trials targeting Lp(a) to reduce ASCVD risk in primary prevention groups, including diverse populations and patients with DM. Moreover, our findings support the appropriateness of screening Lp(a) in the primary prevention setting, including those with DM, providing further relevance to recent recommendations calling for universal screening of Lp(a)."

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