| Title: | Lp(a) (Lipoprotein[a]) Concentrations and Incident Atherosclerotic Cardiovascular Disease |
| Journal: | Arteriosclerosis Thrombosis and Vascular Biology |
| Published: | 29 Oct 2020 |
| Pubmed: | https://pubmed.ncbi.nlm.nih.gov/33115266/ |
| DOI: | https://doi.org/10.1161/atvbaha.120.315291 |
| URL: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769893 |
Publication 5347
WARNING: the interactive features of this website use CSS3, which your browser does not support. To use the full features of this website, please update your browser.
Abstract
OBJECTIVE: Lp(a) (lipoprotein[a]) concentrations are associated with atherosclerotic cardiovascular disease (ASCVD), and new therapies that enable potent and specific reduction are in development. In the largest study conducted to date, we address 3 areas of uncertainty: (1) the magnitude and shape of ASCVD risk conferred across the distribution of lipoprotein(a) concentrations; (2) variation of risk across racial and clinical subgroups; (3) clinical importance of a high lipoprotein(a) threshold to guide therapy. Approach and Results: Relationship of lipoprotein(a) to incident ASCVD was studied in 460 506 middle-aged UK Biobank participants. Over a median follow-up of 11.2 years, incident ASCVD occurred in 22 401 (4.9%) participants. Median lipoprotein(a) concentration was 19.6 nmol/L (25th-75th percentile 7.6-74.8). The relationship between lipoprotein(a) and ASCVD appeared linear across the distribution, with a hazard ratio of 1.11 (95% CI, 1.10-1.12) per 50 nmol/L increment. Substantial differences in concentrations were noted according to race-median values for white, South Asian, black, and Chinese individuals were 19, 31, 75, and 16 nmol/L, respectively. However, risk per 50 nmol/L appeared similar-hazard ratios of 1.11, 1.10, and 1.07 for white, South Asian, and black individuals, respectively. A high lipoprotein(a) concentration defined as ≥150 nmol/L was present in 12.2% of those without and 20.3% of those with preexisting ASCVD and associated with hazard ratios of 1.50 (95% CI, 1.44-1.56) and 1.16 (95% CI, 1.05-1.27), respectively.</p>
CONCLUSIONS: Lipoprotein(a) concentrations predict incident ASCVD among middle-aged adults within primary and secondary prevention contexts, with a linear risk gradient across the distribution. Concentrations are variable across racial subgroups, but the associated risk appears similar.</p>
19 Keywords
- Adult
- Aged
- Atherosclerosis
- Biological Specimen Banks
- Biomarkers
- Female
- Heart Disease Risk Factors
- Humans
- Incidence
- Lipoprotein(a)
- Male
- Middle Aged
- Primary Prevention
- Prognosis
- Race Factors
- Risk Assessment
- Secondary Prevention
- Time Factors
- United Kingdom
7 Authors
- Aniruddh P. Patel
- Minxian Wang
- James P. Pirruccello
- Patrick T. Ellinor
- Kenney Ng
- Sekar Kathiresan
- Amit V. Khera
Enabling scientific discoveries that improve human health