Lipoprotein(a) predicts MACE in patients with or without ASCVD

Increased lipoprotein(a) (Lp[a]) appears predictive of long-term major adverse cardiovascular events (MACE) in people with and without baseline atherosclerotic cardiovascular disease (ASCVD), according to a recent study.

A total of 16,419 patients with Lp(a) measured at two medical centres in Boston, Massachusetts, US, from 2000 to 2019 were included in this retrospective cohort study. Median follow-up was 11.9 years.

The authors generated Lp(a) percentile groups, with the reference group set at the first to 50th Lp(a) percentiles, to examine the relationship of Lp(a) with incidence MACE (ie, nonfatal myocardial infarction [MI], nonfatal stroke, coronary revascularization, or cardiovascular mortality). They also explored the association between Lp(a) percentile groups and MACE using Cox proportional hazards modelling.

Of the participants, 10,181 (62 percent) had ASCVD at baseline. Individuals in the 71st to 90th percentile group showed a higher risk of MACE (adjusted hazard ratio [aHR], 1.21; p<0.001), which was comparable to that of those in the 91st to 100th percentile group (aHR, 1.26; p<0.001).

A continuously higher risk of MACE was observed with increasing Lp(a) among the 6,238 individuals without ASCVD at baseline. In addition, those in the 91st to 100th Lp(a) percentile group showed the highest relative risk (aHR, 1.93; p<0.001).

“Our results suggest that the threshold for risk assessment may be different in primary versus secondary prevention cohorts,” the authors said.