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Independent Association of Lipoprotein(a) and Coronary Artery Calcification With Atherosclerotic Cardiovascular Risk

Anurag Mehta1, Nestor Vasquez2, Colby R Ayers3

  • 1Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.

Journal of the American College of Cardiology
|February 25, 2022
PubMed

Insights

Elevated lipoprotein(a) [Lp(a)] and coronary artery calcium (CAC) score independently increase atherosclerotic cardiovascular disease (ASCVD) risk. Combining Lp(a) and CAC assessments can enhance primary prevention strategies.

Area of Science:

  • Cardiovascular Medicine
  • Preventive Cardiology
  • Biomarkers of Atherosclerosis

Background:

  • Elevated lipoprotein(a) [Lp(a)] and coronary artery calcium (CAC) score are known independent risk factors for atherosclerotic cardiovascular disease (ASCVD).
  • The combined impact of Lp(a) and CAC on ASCVD risk has not been previously investigated.

Purpose of the Study:

  • To evaluate the independent and joint associations of Lp(a) and CAC with ASCVD risk.
  • To determine if Lp(a) and CAC can be used together to refine ASCVD risk assessment.

Main Methods:

  • Analysis of asymptomatic participants from the MESA (n=4,512) and DHS (n=2,078) cohorts.
  • Measurement of plasma Lp(a) and CAC scores at baseline.
  • Utilized risk factor-adjusted Cox regression models to assess associations with incident ASCVD events over 13.2 years of follow-up.

Main Results:

  • Both elevated Lp(a) and higher CAC scores (1-99 and ≥100) were independently associated with increased ASCVD risk.
  • Participants with elevated Lp(a) and CAC ≥100 had the highest ASCVD risk (HR: 4.71).
  • No significant Lp(a)-by-CAC interaction was observed, but combined assessment provided additive risk information.

Conclusions:

  • Lipoprotein(a) and coronary artery calcium are independently linked to ASCVD risk.
  • Concurrent assessment of Lp(a) and CAC may improve the guidance of primary prevention therapy decisions.
Abstract

Keywords:
atherosclerotic cardiovascular diseasecoronary artery calciumlipoprotein(a)primary cardiovascular disease prevention

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