Association of high lipoprotein (a) level with carotid atherosclerosis and all-cause mortality

Lipoprotein (a) Lp(a) is a genetically inherited low-density lipoprotein like particle with proinflammatory, prothrombotic and proatherogenic properties. Current guidelines recommend at least one-time measurement of Lp(a) in cardiovascular risk assessment in each adult person's lifetime.

The present study evaluates the association between exposure to a high circulating level of Lp(a) (≥50mg/dl or ≥125nmol/L) and atherosclerosis and all-cause of death after a very long-term follow-up.

A retrospective analysis was performed on 11,990 subjects admitted to the department of preventive cardiology at Toulouse University Hospital, Rangueil, France and who underwent at least one Lp (a) measurement between September 1995 and December 2023. The living status (alive or dead) of each of study's participants was assessed by March 2024. The study population was divided into two groups: first, according to Lp (a) level (normal versus high circulating Lp (a) level), and second, according to the living status.

High-Lp(a) level group includes 3195 participants. They were significantly more women (47.5 % vs.41.4 %), non-obese (89.1 % vs.84.7 %), sportier (71 % vs. 68.1 %) and normotensive (70.5 % vs. 67.6 %). The adjusted logistic regression on traditional cardiovascular risk factors reveal a positive association between High Lp(a) level and atherogenic findings on doppler ultrasound of carotid arteries [ORa = 1.308;95 %CI(1.182-1.447), p = 0.001]. The all-cause mortality rate was comparable between the two study groups over 13 years of follow-up (7.4 % vs. 8 %). Survival analyses with Kaplan-Meier curves (p = 0.643) and Cox regression [HR = 0.981, 95 %CI (0.844-1.141), p = 0.811] showed no significant difference in survival outcomes.

Long-term exposure to high Lp(a) is a predictor for atherosclerotic cardiovascular disease, but not significantly associated with risk of death from any cause.