Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American College of Cardiology, 83(9), 873–886. https://doi.org/10.1016/j.jacc.2023.12.031 Dr. Adam N. Berman et al.
Points
- The study assessed the association between Lipoprotein(a) (Lp(a)) levels and major adverse cardiovascular events (MACE) in individuals with and without baseline atherosclerotic cardiovascular disease (ASCVD).
- A retrospective cohort analysis included 16,419 individuals from two medical centers in Boston, Massachusetts, from 2000 to 2019.
- Among patients with established ASCVD, those in the 71st to 90th percentile Lp(a) group exhibited a 21% increased hazard of MACE, similar to those observed in the 91st to 100th percentile group.
- With increasing Lp(a) levels, the risk of MACE increased progressively in individuals without established ASCVD, and those in the 91st to 100th percentile group had the highest relative risk of MACE.
- Findings suggest that the optimal threshold for risk assessment based on Lp(a) levels may differ between primary and secondary prevention cohorts, highlighting the need for distinct risk assessment thresholds based on Lp(a) levels in different prevention settings.
Summary
The study aimed to investigate the association between Lipoprotein(a) [Lp(a)] levels and major adverse cardiovascular events (MACE) in individuals with and without baseline atherosclerotic cardiovascular disease (ASCVD). The retrospective cohort analysis included 16,419 individuals from two medical centers in Boston, Massachusetts, from 2000 to 2019. The findings revealed that among the 10,181 patients with established ASCVD, those in the 71st to 90th percentile Lp(a) group exhibited a 21% increased hazard of MACE, comparable to the hazard observed in the 91st to 100th percentile group. In contrast, among the 6,238 individuals without established ASCVD, there was a progressively higher risk of MACE with increasing Lp(a) levels. Those in the 91st to 100th percentile group had the highest relative risk of MACE.
This significant, contemporary U.S. cohort demonstrated an independent association between elevated Lp(a) levels and long-term MACE in individuals with and without baseline ASCVD. Notably, the study’s findings suggested that the optimal threshold for risk assessment based on Lp(a) levels may differ between primary and secondary prevention cohorts. Specifically, the data indicated that in primary prevention cohorts, individuals in the highest Lp(a) percentile group had the highest relative risk of MACE. In contrast, in secondary prevention cohorts, individuals in the 71st to 90th percentile group exhibited a substantial hazard of MACE, comparable to those in the 91st to 100th percentile group.
In summary, the study provided valuable insights into the differential association of Lp(a) levels with MACE in individuals with and without established ASCVD, highlighting the potential need for distinct risk assessment thresholds in primary and secondary prevention settings based on Lp(a) levels.
Link to the article: https://www.sciencedirect.com/science/article/abs/pii/S073510972400007X
References Berman, A. N., Biery, D. W., Besser, S. A., Singh, A., Shiyovich, A., Weber, B. N., Huck, D. M., Divakaran, S., Hainer, J., Kaur, G., Blaha, M. J., Cannon, C. P., Plutzky, J., Januzzi, J. L., Booth, J. N., López, J. A. G., Kent, S. T., Nasir, K., Di Carli, M. F., … Blankstein, R. (2024). Lipoprotein(a) and Major Adverse Cardiovascular Events in Patients With or Without Baseline Atherosclerotic Cardiovascular Disease. Journal of the American College of Cardiology, 83(9), 873–886. https://doi.org/10.1016/j.jacc.2023.12.031
