Lipoprotein(a) and ethnicities.

Area of Science:

• Cardiovascular Medicine
• Genetics
• Epidemiology

Background:

• Initial research on lipoprotein(a) [Lp(a)] and atherosclerotic cardiovascular disease (ASCVD) focused solely on White populations.
• Decades of research reveal significant race/ethnic disparities in plasma Lp(a) concentrations and distribution.
• Blacks exhibit the highest Lp(a) levels, followed by South Asians, Whites, Hispanics, and East Asians.

Purpose of the Study:

• To review the evidence on race/ethnic differences in Lp(a) levels and explore underlying genetic mechanisms.
• To examine the association between elevated Lp(a) and cardiovascular disease risk across diverse populations.
• To discuss the challenges in establishing appropriate Lp(a) thresholds for risk prediction and preventive therapy.

Main Methods:

• Systematic review of large-scale, independent investigations on Lp(a) concentration and cardiovascular risk.
• Analysis of genetic factors contributing to observed race/ethnic differences in Lp(a) levels.
• Evaluation of studies assessing Lp(a) association with cardiovascular disease risk in various race/ethnic groups.

Main Results:

• Consistent race/ethnic variations in plasma Lp(a) levels have been established over four decades.
• Elevated Lp(a) is generally associated with increased cardiovascular risk across all studied groups.
• Significant challenges exist in defining universal Lp(a) thresholds due to population-specific differences.

Conclusions:

• Genetic factors play a crucial role in explaining race/ethnic disparities in Lp(a) levels.
• While Lp(a) is a risk factor across groups, race/ethnic differences complicate risk stratification.
• Further research is needed to identify precise Lp(a) thresholds for effective cardiovascular risk management in diverse populations.