Lipoprotein(a) and Its Association with Coronary Heart Disease: Data from a Large Cohort in the Russian

Aim      To study the distribution of lipoprotein(a) [Lp(a)] concentrations in a large sample of the adult population of the Russian Federation depending on gender and age, and the Lp(a) association with the incidence of ischemic heart disease (IHD).Material and methods  Cross-analysis of electronic medical records of patients older than 18 years managed in the MEDSI Group of Companies as a part of primary and secondary prevention.Results Among 73,763 patients, the mean age was 45 [37; 56] years, 57.3% were women. The median Lp(a) concentration was 11 [6.0; 32.0] mg/dl. The median Lp(a) concentration in women was higher than in men, 12.0 and 10.5 mg/dl, respectively (p<0.0001). Hyperlipoproteinemia(a) (Lp(a) >30 mg/dl) was diagnosed in 26% (n=19,188) of patients (95% confidence interval (CI): 25.7-26.3), statistically significant association with IHD was observed over the entire range of elevated Lp(a) concentrations (p<0.001). Extremely high Lp(a) concentrations exceeding 180 mg/dl were detected in 852 (1.2%) of patients, and 210 of them were diagnosed with IHD. Logistic regression analysis confirmed a significant association between Lp(a) concentrations and IHD (odds ratio (OR) 1.006; 95% CI 1.003-1.008; p<0.001). With an increase in Lp(a) by 1 mg/dl, the likelihood of having IHD increased by 1.006 times. With Lp(a) >50 mg/dL, the likelihood of IHD increased by 1.32 times (OR 1.320; 95% CI 1.254-1.390; p<0.001), with Lp(a) >180 mg/dL, by 2.06 times (OR 2.058; 95% CI 1.758-2.408), and with Lp(a) 30-50 mg/dL, by 1.1 times (OR 1.100; 95% CI 1.017-1.188; p=0.016).Conclusion      Every fourth person has an elevated Lp(a) concentration, which determines a high risk of developing cardiovascular diseases. Taking into account the accumulated data, early assessment of the Lp(a) concentration is necessary for all adults.