Lipoprotein(a) and Atherosclerotic Cardiovascular Disease Among Adults Aged 20 to 100 Years

High lipoprotein(a) is considered a causal risk factor for atherosclerotic cardiovascular diseases (ASCVD); however, whether the association between lipoprotein(a) and ASCVD is different among older individuals (defined as 70-100 years of age) compared with younger individuals is unclear. We evaluated differences in risk of ASCVD associated with high lipoprotein(a) stratified by age and sex.

We included 57 899 women and 45 442 men aged 20 to 100 years from the Copenhagen General Population Study, of which 18 322 (18%) were aged 70 to 100 years. Age-stratified incidence rates and hazard ratios for ASCVD were estimated. Secondary analyses were additionally stratified by sex.

During a median follow-up of 12.5 years (maximum, 19.1), 9091 individuals were diagnosed with ASCVD. ASCVD incidence increase per 50 mg/dL (105 nmol/L) higher lipoprotein(a) were 0.3 per 1000 person-years (95% CI, 0.2-0.4) for age 20 to 49 years, 0.8 (0.6-0.9) for age 50 to 59 years, 1.5 (1.2-1.7) for age 60 to 69 years, 2.7 (2.2-3.2) for age 70 to 79 years, and 4.5 per 1000 person-years (3.7-5.4) for age 80 to 100 years. For lipoprotein(a) of 70 to 89 mg/dL (148-190 nmol/L), such incidence increases were 2.7 for age 20 to 49 years, 7.1 for age 50 to 59 years, 13.3 for age 60 to 69 years, 24.4 for age 70 to 79 years, and 40.9 for age 80 to 100 years. Corresponding values for lipoprotein(a) of 90 to 426 mg/dL (191-924 nmol/L) were 3.2, 8.3, 15.6, 28.7, and 48, respectively. The above results were similar in women and men, but with the highest incidence increases in men. Hazard ratios per 50 mg/dL higher lipoprotein(a) were similar across all age groups and sexes, ranging from 1.12 to 1.18 (P_interaction: by age=0.48; by sex=0.74).

In a contemporary primary prevention cohort, the relative risk increase of ASCVD with higher lipoprotein(a) levels was similar for individuals aged older (aged 70-100 years) and younger individuals, with the highest absolute risk in this older age group.