Serially increasing change in lipoprotein(a) concentration has predictive value in acute vascular events

Lipoprotein(a) (Lp(a)) has been regarded in some studies as an independent risk factor of atherosclerotic vascular disease. However, the use of a baseline plasma Lp(a) concentration as a screening tool for future acute vascular events (AVE) is controversial. We therefore investigated whether progressively increasing change in plasma Lp(a) concentration is associated with the development of AVE.

We investigated prospective analyses of 985 participants (464 women and 521 men) who had either clinically evident vascular disease (VD group, n=443) or its risk factor(s) (RF group, n=542). Blood samples were taken from all participants every six months to measure inflammatory markers such as Lp(a) and C-reactive protein during a 10-year follow-up period.

During the follow-up, 223 new cases of myocardial infarction, stroke, and peripheral arterial disease were identified. In the RF group, the relative risk of positive Delta Lp(a) for predicting AVE was 4.36 (95% confidence interval [CI] 1.76-10.85; P=0.002). In the VD group, the relative risk of positive Delta Lp(a) for predicting AVE was 6.35 (95% CI 3.68-10.97; P<0.001).

These results suggest that a progressively increasing change in Lp(a) concentration has a highly significant predictive value in AVE in both the VD and the RF groups.