The Family Heart Foundation announced the results of the largest study to date involving individuals with cardiovascular disease and a confirmed measurement of lipoprotein(a) [Lp(a)]. The findings, presented at the European Atherosclerosis Society Congress in Glasgow, Scotland, and simultaneously published in the European Heart Journal, show a clear and continuous link between rising Lp(a) levels and increased risk of cardiovascular events such as heart attack and stroke.
While smaller studies have suggested increased cardiovascular risk at certain Lp(a) thresholds, this is the first large-scale study to demonstrate that the risk of events, including heart attacks, strokes, and cardiac surgeries, continues to rise across all increasing Lp(a) levels, with no sign of plateauing. These findings strongly support the inclusion of Lp(a) levels as part of standard cardiovascular risk assessment.
The study tracked health outcomes over a median of 5.4 years in a diverse cohort of 273,770 adults living with atherosclerotic cardiovascular disease (ASCVD). Researchers evaluated whether participants experienced another cardiovascular event, such as a myocardial infarction, ischaemic stroke, or procedures like percutaneous coronary intervention or coronary artery bypass grafting, based on their Lp(a) levels.
Among participants, 33% had low Lp(a) levels (<15 nmol/L), 33% had moderate levels (15–79 nmol/L), 15% had moderate-to-high levels (80–179 nmol/L), 10% had high levels (180–299 nmol/L) and 5% had very high levels (≥300 nmol/L).
The study is the first to show that cardiovascular risk rises steadily with each incremental increase in Lp(a), starting from even the lowest levels. Women and Black individuals were found to be more likely to have elevated Lp(a) levels.
This study demonstrates that every additional nmol/L of Lp(a) confers greater risk of a cardiovascular event in people with existing cardiovascular disease. The increased risk persists regardless of the type of initial cardiovascular disease, whether individuals had diabetes, or their sex or race/ethnicity. The higher the Lp(a), the higher the risk.
While no therapies are currently approved specifically to lower Lp(a), several investigational treatments are in late-stage development. This study also evaluated whether lowering LDL-C (low-density lipoprotein cholesterol) could help reduce risk in individuals with high Lp(a). Findings revealed that among participants with ASCVD and Lp(a) levels ≥180 nmol/L, those using intensive LDL-C lowering therapies, such as high-dose statins and PCSK9 inhibitors, had a lower risk of experiencing another cardiovascular event compared to those using less intensive or no LDL-C lowering medications.
The study data were drawn from the Family Heart Database®, a large real-world dataset managed by the Family Heart Foundation comprising medical claims from 340 million U.S. individuals between 2012 and 2022. The database is used to examine patterns in medical care and outcomes among individuals with lipid disorders and cardiovascular risk.
Source: European Heart Journal
Image Credit: iStock
