Elevated Lipoprotein(a) Associated With Increased Risk of Major Adverse Cardiovascular Events

Elevated lipoprotein(a) (Lp[a]) is linked to increased risk of major adverse cardiovascular events (MACE) independent of atherosclerotic cardiovascular disease (ASCVD) risk scoring, according to a study to be presented at the American Heart Association’s Scientific Sessions 2023, taking place November 11-13 in Philadelphia, Pennsylvania, and published in the journal Circulation.

In this analysis, investigators conducted an observational, retrospective study comprising 362,061 Caucasian (94.3%) and Black (1.6%) individuals from the UK Biobank between 2006 and 2020. They assessed the link between Lp(a) levels with time to first MACE and myocardial infarction (MI) using Cox proportional hazard models adjusted for age, sex, and ethnicity, while stratifying by ASCVD risk score across 10-year risk categories.

According to the findings, MACE incidence rates (IRs, per 100 person/years) increased with 10-year ASCVD risk score, which was broken up into 3 groups: low-risk IR, 0.14 (n=161,183); intermediate-risk IR, 0.72 (n=121,272); and high-risk IR, 1.52 (n=27,733). The researchers observed that elevated Lp(a) led to a notable increase in risk of MACE and MI. They noted that in the low-risk category, hazard ratios (HRs) ranged from 1.15 to 1.55 (MACE) and 1.32 to 1.72 (MI). In the intermediate-risk category, HRs ranged from 1.19 to 1.51 (MACE) and 1.37 to 1.77 (MI). HRs ranged from 1.12 to 1.55 (MACE) and 1.14 to 1.76 (MI) in the high-risk category.

“Our study demonstrates that elevated Lp(a) increases the risk of MACE independently of ASCVD risk score. Measuring and considering elevated Lp(a) levels as part of individual ASCVD risk assessment in routine clinical practice may help improve the risk predication,” the researchers concluded.