| Title: | Lipoprotein(a) and cardiovascular disease: prediction, attributable risk fraction, and estimating benefits from novel interventions |
| Journal: | European Journal of Preventive Cardiology |
| Published: | 7 Oct 2020 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/33624048/ |
| DOI: | https://doi.org/10.1093/eurjpc/zwaa063 |
| URL: | https://academic.oup.com/eurjpc/advance-article-pdf/doi/10.1093/eurjpc/zwaa063/36341323/zwaa063.pdf |
Publication 5328
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Abstract
AIMS: To investigate the population attributable fraction due to elevated lipoprotein (a) (Lp(a)) and the utility of measuring Lp(a) in cardiovascular disease (CVD) risk prediction.</p>
METHODS AND RESULTS: In 413 734 participants from UK Biobank, associations of serum Lp(a) with composite fatal/non-fatal CVD (n = 10 066 events), fatal CVD (n = 3247), coronary heart disease (CHD; n = 18 292), peripheral vascular disease (PVD; n = 2716), and aortic stenosis (n = 901) were compared using Cox models. Median Lp(a) was 19.7 nmol/L (interquartile interval 7.6-75.3 nmol/L). About 20.8% had Lp(a) values >100 nmol/L; 9.2% had values >175 nmol/L. After adjustment for classical risk factors, 1 SD increment in log Lp(a) was associated with a hazard ratio for fatal/non-fatal CVD of 1.12 [95% confidence interval (CI) 1.10-1.15]. Similar associations were observed with fatal CVD, CHD, PVD, and aortic stenosis. Adding Lp(a) to a prediction model containing traditional CVD risk factors in a primary prevention group improved the C-index by +0.0017 (95% CI 0.0008-0.0026). In the whole cohort, Lp(a) above 100 nmol/L was associated with a population attributable fraction (PAF) of 5.8% (95% CI 4.9-6.7%), and for Lp(a) above 175 nmol/L the PAF was 3.0% (2.4-3.6%). Assuming causality and an achieved Lp(a) reduction of 80%, an ongoing trial to lower Lp(a) in patients with CVD and Lp(a) above 175 nmol/L may reduce CVD risk by 20.0% and CHD by 24.4%. Similar benefits were also modelled in the whole cohort, regardless of baseline CVD.</p>
CONCLUSION: Population screening for elevated Lp(a) may help to predict CVD and target Lp(a) lowering drugs, if such drugs prove efficacious, to those with markedly elevated levels.</p>
6 Keywords
- Cardiovascular Diseases
- Cohort Studies
- Coronary Disease
- Humans
- Lipoprotein(a)
- Risk Factors
15 Authors
- Paul Welsh
- Claire Welsh
- Carlos A Celis-Morales
- Rosemary Brown
- Frederick K Ho
- Lyn D Ferguson
- Patrick B Mark
- James Lewsey
- Stuart R Gray
- Donald M Lyall
- Jason M R Gill
- Jill P Pell
- James A de Lemos
- Peter Willeit
- Naveed Sattar
1 Application
| Application ID | Title |
|---|---|
| 9310 | Associations of blood biomarkers with cardiovascular disease and related cardiometabolic outcomes and risk prediction in the clinical setting |
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