Finding very high lipoprotein(a): the need for routine assessment

Area of Science:

• Cardiology
• Clinical Lipidology
• Preventive Medicine

Background:

• Elevated lipoprotein(a) [Lp(a)] is linked to increased atherosclerotic cardiovascular disease (ASCVD) risk.
• The clinical utility of routine Lp(a) assessment for risk stratification remains under investigation.

Purpose of the Study:

• To validate the association between very high Lp(a) levels and ASCVD risk.
• To evaluate the impact of incorporating Lp(a) testing into established risk algorithms for patient reclassification.

Main Methods:

• A cross-sectional, case-control study involving 12,437 patients undergoing lipid testing.
• Age and sex-matched comparison of individuals with Lp(a) >99th percentile versus Lp(a) ≤20th percentile.
• Multivariable logistic regression analysis to determine odds ratios for ASCVD and myocardial infarction (MI), adjusted for key risk factors.

Main Results:

• Individuals with Lp(a) >99th percentile exhibited a 2.64-fold increased odds of ASCVD and a 3.39-fold increased odds of MI.
• Incorporating Lp(a) into risk algorithms led to significant reclassification: 31% for Systematic Coronary Risk Evaluation (SCORE) and 63% for Second Manifestations of ARTerial disease (SMART).

Conclusions:

• Very high Lp(a) levels are associated with a nearly three-fold higher prevalence of ASCVD.
• Routine Lp(a) assessment effectively reclassifies patients, improving risk stratification for both primary and secondary prevention.