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Published on: October 12, 2017

Combined effect of elevated lipoprotein (a) and high-sensitivity C-reactive protein on the risk of coronary heart

Longwei Yang1, Junxiang Sun2, Qian Zhuang2

  • 1Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China.

Clinica Chimica Acta; International Journal of Clinical Chemistry
|May 15, 2026
PubMed

Insights

Elevated lipoprotein (a) [Lp(a)] increases coronary heart disease (CHD) risk in Chinese individuals with high-sensitivity C-reactive protein (hsCRP). This suggests inflammation drives Lp(a)s harmful effects on heart health.

Area of Science:

  • Cardiovascular Medicine
  • Biomarkers
  • Epidemiology

Background:

  • Elevated lipoprotein (a) [Lp(a)] is a known risk factor for coronary heart disease (CHD) in European populations, particularly when systemic inflammation is present.
  • Limited evidence exists regarding the combined impact of Lp(a) and inflammation on CHD risk in Chinese populations.

Purpose of the Study:

  • To investigate the synergistic effects of elevated Lp(a) and high-sensitivity C-reactive protein (hsCRP) on CHD risk within a Chinese cohort.
  • To determine if inflammation modifies the association between Lp(a) and cardiovascular outcomes.

Main Methods:

  • A prospective cohort study involving 4128 participants with a median follow-up of 14.16 years.
  • Stratification of Lp(a) and hsCRP levels into age- and sex-specific tertiles using Generalized Additive Models for Location, Scale and Shape (GAMLSS) analysis.
  • Cox proportional hazards models and competing risk models were employed to assess CHD risk, interactions, and population attributable fraction (PAF).

Main Results:

  • Lp(a) alone was not significantly associated with CHD risk in the overall Chinese population.
  • In participants with the highest hsCRP tertile, elevated Lp(a) levels (medium and high tertiles) were associated with significantly increased CHD risk (HRs 1.837 and 2.021, respectively).
  • Significant additive and multiplicative interactions between Lp(a) and hsCRP on CHD risk were observed, with dual-high risk groups exhibiting the highest hazard.

Conclusions:

  • The pathogenic effect of high Lp(a) on CHD development is significantly influenced by the presence of elevated hsCRP, indicating a critical role for hyperinflammation.
  • These findings highlight the importance of considering inflammatory status when assessing cardiovascular risk associated with Lp(a) in Chinese populations.
Abstract

Keywords:
Combined effectCoronary heart diseaseHigh-sensitivity C-reactive proteinLipoprotein (a)Population attributable fraction

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