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Lp(a) (Lipoprotein[a]) Concentrations and Incident Atherosclerotic Cardiovascular Disease: New Insights From a Large National Biobank

Arteriosclerosis, thrombosis, and vascular biology, 2021-01, Vol.41 (1), p.465-474 [Peer Reviewed Journal]

2020 American Heart Association, Inc. ;ISSN: 1079-5642 ;EISSN: 1524-4636 ;DOI: 10.1161/ATVBAHA.120.315291 ;PMID: 33115266

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  • Title:
    Lp(a) (Lipoprotein[a]) Concentrations and Incident Atherosclerotic Cardiovascular Disease: New Insights From a Large National Biobank
  • Author: Patel, Aniruddh P ; Wang, Minxian ; Pirruccello, James P ; Ellinor, Patrick T ; Ng, Kenney ; Kathiresan, Sekar ; Khera, Amit V
  • Subjects: Adult ; Aged ; Atherosclerosis - blood ; Atherosclerosis - diagnosis ; Atherosclerosis - epidemiology ; Atherosclerosis - prevention & control ; Biological Specimen Banks ; Biomarkers - blood ; Female ; Heart Disease Risk Factors ; Humans ; Incidence ; Lipoprotein(a) - blood ; Male ; Middle Aged ; Primary Prevention ; Prognosis ; Race Factors ; Risk Assessment ; Secondary Prevention ; Time Factors ; United Kingdom
  • Is Part Of: Arteriosclerosis, thrombosis, and vascular biology, 2021-01, Vol.41 (1), p.465-474
  • Description: OBJECTIVE:Lipoprotein(a) concentrations are associated with atherosclerotic cardiovascular disease (ASCVD), and new therapies that enable potent and specific reduction are in development. In the largest study conducted to date, we address 3 areas of uncertainty(1) the magnitude and shape of ASCVD risk conferred across the distribution of lipoprotein(a) concentrations; (2) variation of risk across racial and clinical subgroups; (3) clinical importance of a high lipoprotein(a) threshold to guide therapy. APPROACH AND RESULTS:Relationship of lipoprotein(a) to incident ASCVD studied in 460 506 middle-aged UK Biobank participants. Over a median follow-up of 11.2 years, incident ASCVD occurred in 22 401 (4.9%) participants. Median lipoprotein(a) concentration was 19.6 nmol/L (25th–75th percentile 7.6–74.8). The relationship between lipoprotein(a) and ASCVD appeared linear across the distribution, with a hazard ratio of 1.11 (95% CI, 1.10–1.12) per 50 nmol/L increment. Substantial differences in concentrations were noted according to race—median values for white, South Asian, black, and Chinese individuals were 19, 31, 75, and 16 nmol/L, respectively. However, risk per 50 nmol/L appeared similar—hazard ratios of 1.11, 1.10, and 1.07 for white, South Asian, and black individuals, respectively. A high lipoprotein(a) concentration defined as ≥150 nmol/L was present in 12.2% of those without and 20.3% of those with preexisting ASCVD and associated with hazard ratios of 1.50 (95% CI, 1.44–1.56) and 1.16 (95% CI, 1.05–1.27), respectively. CONCLUSIONS:Lipoprotein(a) concentrations predict incident ASCVD among middle-aged adults within primary and secondary prevention contexts, with a linear risk gradient across the distribution. Concentrations are variable across racial subgroups, but the associated risk appears similar.
  • Publisher: United States: American Heart Association, Inc
  • Language: English
  • Identifier: ISSN: 1079-5642
    EISSN: 1524-4636
    DOI: 10.1161/ATVBAHA.120.315291
    PMID: 33115266
  • Source: Geneva Foundation Free Medical Journals at publisher websites
    MEDLINE
    Alma/SFX Local Collection
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