Elevated Lp(a) independently associated with long-term MACE among individuals with and without baseline ASCVD: JACC

A recent study unveiled a crucial link between Lipoprotein(a) [Lp(a)] levels and the risk of atherosclerotic cardiovascular disease (ASCVD). The findings were published in the Journal of the American College of Cardiology and explored the intricate relationship between Lp(a) and major adverse cardiovascular events (MACE).

The study was conducted across two medical centers in Boston, Massachusetts, analyzed data from over 16,000 individuals that spanned nearly two decades to determine the association between Lp(a) levels and the incidence of MACE among patients with and without pre-existing ASCVD. This research utilizing Cox proportional hazards modeling and categorized participants into Lp(a) percentile groups and evaluated their risk of MACE, including nonfatal myocardial infarction (MI), nonfatal stroke, coronary revascularization or cardiovascular mortality.

The results from the analysis found that out of the 62% of patients with baseline ASCVD, the individuals in the 71st to 90th percentile Lp(a) group expressed a notable 21% increased hazard of MACE, close to those in the 91st to 100th percentile group. Also, among the remaining participants without established ASCVD, there was a progressive increase in MACE risk with rising Lp(a) levels, with the individuals in the highest percentile group facing a sharp 93% relative risk increase. These findings challenge conventional risk assessment paradigms suggests that the optimal Lp(a) threshold for gauging cardiovascular risk may differ based on the individuals in the primary or secondary prevention cohorts. 

Reference:

Berman, A. N., Biery, D. W., Besser, S. A., Singh, A., Shiyovich, A., Weber, B. N., Huck, D. M., Divakaran, S., Hainer, J., Kaur, G., Blaha, M. J., Cannon, C. P., Plutzky, J., Januzzi, J. L., Booth, J. N., III, López, J. A. G., Kent, S. T., Nasir, K., Di Carli, M. F., … Blankstein, R. (2024). Lipoprotein(a) and Major Adverse Cardiovascular Events in Patients With or Without Baseline Atherosclerotic Cardiovascular Disease. In Journal of the American College of Cardiology (Vol. 83, Issue 9, pp. 873–886). Elsevier BV. https://doi.org/10.1016/j.jacc.2023.12.031