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Lipoprotein(a), High-Sensitivity C-Reactive Protein, and Incident ASCVD Risk in Individuals Without Standard

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Assessing lipoprotein(a) [Lp(a)] and high-sensitivity C-reactive protein (hsCRP) together improves atherosclerotic cardiovascular disease (ASCVD) risk prediction in individuals without standard risk factors. Combined elevation indicates the highest risk.

Keywords:
ASCVDLipoprotein(a)SMuRFUK BiobankhsCRPinflammation

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Area of Science:

  • Cardiology
  • Biomarkers
  • Preventive Medicine

Background:

  • Prognostic value of combined lipoprotein(a) [Lp(a)] and high-sensitivity C-reactive protein (hsCRP) in primary prevention for individuals without standard modifiable risk factors (SMuRFs) is not well understood.
  • SMuRFs include absence of smoking, obesity, hypertension, dyslipidemia, and diabetes.

Purpose of the Study:

  • To evaluate the independent and combined prognostic value of Lp(a) and hsCRP for atherosclerotic cardiovascular disease (ASCVD) risk in SMuRF-less individuals.
  • To determine if combined assessment of these biomarkers enhances ASCVD risk stratification in primary prevention.

Main Methods:

  • Analysis of 50,450 UK Biobank participants without baseline cardiovascular disease or SMuRFs.
  • Incident ASCVD events (myocardial infarction, ischemic stroke, cardiovascular death) ascertained over 15 years.
  • Fine-Gray competing-risk regression models used to assess associations, accounting for competing non-cardiovascular death.

Main Results:

  • Elevated hsCRP (sHR 1.35) and Lp(a) (sHR 1.24) were independently associated with increased ASCVD risk using cohort-specific cutoffs.
  • Concurrent elevations in both Lp(a) and hsCRP showed the highest ASCVD risk (sHR 1.64).
  • Similar patterns observed using established clinical cutoffs, with combined elevation yielding the greatest risk (sHR 1.74).

Conclusions:

  • Lipoprotein(a) [Lp(a)] and high-sensitivity C-reactive protein (hsCRP) independently predict ASCVD risk in individuals without standard modifiable risk factors (SMuRFs).
  • Combined assessment of Lp(a) and hsCRP provides complementary information for ASCVD risk characterization in SMuRF-less adults during primary prevention.