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Lipoprotein(a) and Family History Predict Cardiovascular Disease Risk

Anurag Mehta1, Salim S Virani2, Colby R Ayers3

  • 1Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia. Electronic address: https://twitter.com/amehta_09.

Journal of the American College of Cardiology
|August 15, 2020
PubMed

Insights

Elevated lipoprotein(a) (Lp[a]) and family history (FHx) of coronary heart disease (CHD) independently increase cardiovascular risk. Combining Lp[a] testing with FHx assessment improves risk prediction and guides prevention strategies.

Area of Science:

  • Cardiology
  • Genetics
  • Preventive Medicine

Background:

  • Elevated lipoprotein(a) (Lp[a]) and family history (FHx) of coronary heart disease (CHD) are known cardiovascular risk factors.
  • Lp[a] testing is often performed in individuals with a FHx of CHD.

Purpose of the Study:

  • To investigate the independent and combined associations of Lp[a] and FHx with atherosclerotic cardiovascular disease (ASCVD) and CHD in asymptomatic individuals.
  • To evaluate the utility of combining Lp[a] and FHx for cardiovascular risk assessment.

Main Methods:

  • Two cohorts (ARIC and DHS) with plasma Lp[a] measurements and FHx ascertainment were analyzed.
  • Elevated Lp[a] was defined as the highest race-specific quintile.
  • Cox regression models adjusted for cardiovascular risk factors were used to determine associations.

Main Results:

  • Both FHx and elevated Lp[a] were independently associated with increased ASCVD risk.
  • Individuals with both elevated Lp[a] and FHx exhibited the highest ASCVD risk (HR: 1.43).
  • The combination of elevated Lp[a] and FHx significantly improved risk reclassification and discrimination for ASCVD and CHD compared to either marker alone.

Conclusions:

  • Elevated Lp[a] and FHx have independent and additive joint associations with cardiovascular risk.
  • Concurrent assessment of Lp[a] and FHx can enhance cardiovascular risk prediction.
  • Combining Lp[a] and FHx may aid in guiding primary prevention therapy decisions.
Abstract

Keywords:
atherosclerotic cardiovascular diseasecardiovascular riskfamily historylipoprotein(a)primary CVD prevention

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