Lipoprotein (a) and incident coronary heart disease in the community: impact of traditional cardiovascular risk factors - Report - MDSpire

Lipoprotein (a) and incident coronary heart disease in the community: impact of traditional cardiovascular risk factors

  • By

  • Natalie Arnold

  • Alina Goßling

  • Benjamin Bay

  • Jessica Weimann

  • Christopher Blaum

  • Fabian J Brunner

  • Marco M Ferrario

  • Paolo Brambilla

  • Giancarlo Cesana

  • Valerio Leoni

  • Luigi Palmieri

  • Chiara Donfrancesco

  • Teresa Padró

  • Jonas Andersson

  • Pekka Jousilahti

  • Francisco Ojeda

  • Tanja Zeller

  • Allan Linneberg

  • Stefan Söderberg

  • Licia Iacoviello

  • Francesco Gianfagna

  • Susana Sans

  • Giovanni Veronesi

  • Barbara Thorand

  • Annette Peters

  • Hugh Tunstall-Pedoe

  • Frank Kee

  • Veikko Salomaa

  • Renate B Schnabel

  • Kari Kuulasmaa

  • Stefan Blankenberg

  • Christoph Waldeyer

  • Wolfgang Koenig

  • on behalf of the BiomarCARE investigators

  • June 12, 2025

  • 0 min

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Lp(a) Levels Predict Coronary Heart Disease Risk Regardless of Traditional Risk Factors

Overview

In a large European cohort of 66,495 CHD-free individuals, elevated Lipoprotein (a) (Lp(a)) levels (≥90th percentile) were associated with increased incident coronary heart disease (CHD) risk independent of traditional cardiovascular risk factor (CVRF) burden. This association was similarly strong in both low-risk individuals (0/1 CVRF) and those with ≥2 CVRFs over a median 9.7-year follow-up.

Background

Lipoprotein (a) is a genetically determined LDL-like particle implicated in atherosclerotic cardiovascular disease (ASCVD). While genetic evidence supports Lp(a) as an independent risk factor, therapeutic options to lower Lp(a) are still under investigation. Currently, mitigating Lp(a)-related risk relies on controlling traditional modifiable cardiovascular risk factors such as hypertension, diabetes, hypercholesterolemia, and smoking. However, it remains unclear whether elevated Lp(a) confers similar CHD risk across different baseline CVRF profiles in primary prevention.

Data Highlights

GroupNumber of SubjectsIncident CHD EventsMedian Follow-up (years)Sub-distribution Hazard Ratio (sHR) for Elevated Lp(a) (≥90th percentile)95% Confidence Interval
0/1 CVRF (Low Risk)41,770Not specified9.71.381.12–1.71
≥2 CVRFs (Increased Risk)24,725Not specified9.71.271.10–1.46

Key Findings

  • Elevated Lp(a) levels (≥90th percentile, ≥43.2 mg/dL) are independently associated with increased incident CHD risk in a large European population cohort.
  • This association is observed both in individuals with low traditional CVRF burden (0/1 CVRF) and those with higher burden (≥2 CVRFs), with similar hazard ratios (1.38 vs. 1.27 respectively).
  • The interaction between Lp(a) levels and CVRF burden on CHD risk was not statistically significant (Pinteraction = 0.50), indicating consistent risk across risk strata.
  • Individuals with elevated Lp(a) but low traditional risk factors still face substantial CHD risk, highlighting challenges in primary prevention.
  • Current strategies to mitigate Lp(a)-related risk focus on controlling modifiable CVRFs, as direct Lp(a)-lowering therapies are still under clinical evaluation.

Clinical Implications

Clinicians should recognize that elevated Lp(a) confers increased CHD risk even in patients with few or no traditional cardiovascular risk factors. This underscores the importance of comprehensive risk assessment including Lp(a) measurement, especially in individuals considered low risk by conventional factors. Until Lp(a)-targeted therapies become available, aggressive management of modifiable CVRFs remains essential to reduce overall cardiovascular risk in patients with high Lp(a).

Conclusion

Elevated Lp(a) is a significant and independent predictor of incident coronary heart disease across different levels of traditional cardiovascular risk. These findings highlight the need for future therapies targeting Lp(a) and reinforce the importance of managing traditional risk factors to mitigate Lp(a)-associated CHD risk.

References

  1. BiomarCaRE Consortium 2024 -- The Relationship Between Lipoprotein (a) Levels and New Cases of Coronary Heart Disease

Original Source(s)

Lipoprotein (a) and incident coronary heart disease in the community: impact of traditional cardiovascular risk factors

  • by Natalie Arnold, Alina Goßling, Benjamin Bay, Jessica Weimann, Christopher Blaum, Fabian J Brunner, Marco M Ferrario, Paolo Brambilla, Giancarlo Cesana, Valerio Leoni, Luigi Palmieri, Chiara Donfrancesco, Teresa Padró, Jonas Andersson, Pekka Jousilahti, Francisco Ojeda, Tanja Zeller, Allan Linneberg, Stefan Söderberg, Licia Iacoviello, Francesco Gianfagna, Susana Sans, Giovanni Veronesi, Barbara Thorand, Annette Peters, Hugh Tunstall-Pedoe, Frank Kee, Veikko Salomaa, Renate B Schnabel, Kari Kuulasmaa, Stefan Blankenberg, Christoph Waldeyer, Wolfgang Koenig, on behalf of the BiomarCARE investigators

  • June 12, 2025

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