TY - JOUR
T1 - Lipoprotein (a) and Incident Coronary Heart Disease in the Community
T2 - Impact of Traditional Cardiovascular Risk Factors
AU - Arnold, Natalie
AU - Goßling, Alina
AU - Bay, Benjamin
AU - Weimann, Jessica
AU - Blaum, Christopher
AU - Brunner, Fabian J
AU - Ferrario, Marco M
AU - Brambilla, Paolo
AU - Cesana, Giancarlo
AU - Leoni, Valerio
AU - Palmieri, Luigi
AU - Donfrancesco, Chiara
AU - Padró, Teresa
AU - Andersson, Jonas
AU - Jousilahti, Pekka
AU - Ojeda, Francisco
AU - Zeller, Tanja
AU - Linneberg, Allan
AU - Söderberg, Stefan
AU - Iacoviello, Licia
AU - Gianfagna, Francesco
AU - Sans, Susana
AU - Veronesi, Giovanni
AU - Thorand, Barbara
AU - Peters, Annette
AU - Tunstall-Pedoe, Hugh
AU - Kee, Frank
AU - Salomaa, Veikko
AU - Schnabel, Renate B
AU - Kuulasmaa, Kari
AU - Blankenberg, Stefan
AU - Waldeyer, Christoph
AU - Koenig, Wolfgang
N1 - © The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2025/6/12
Y1 - 2025/6/12
N2 - AIMS: Deleterious effects Lipoprotein (a) (Lp(a)) might be mitigated by overall cardiovascular (CV) risk reduction. However, data on the relationship between increased Lp(a) and incident coronary heart disease (CHD) according to the distribution of modifiable CV risk factors (CVRF) at baseline are still scarce. We investigated the association between high Lp(a) and incident CHD in the general population, depending on the presence/absence of four major CVRFs (hypertension, diabetes, hypercholesterolemia, smoking) at baseline.METHODS: Overall 66,495 CHD-free individuals from eight European prospective population-based cohorts were included. The cohort was stratified according to CVRF burden at baseline in "0/1 CVRF" (low risk; n= 41,770) and"≥2 CVRFs" (increased risk; n=24,725). Fine and Gray competing risk-adjusted models were calculated for the association between Lp(a) mass (<90th versus ≥90th percentile (pctl.); cut-off 43.2 mg/dL) and future CHD events.RESULTS: During a median follow-up of 9.7 years, 3,467 incident CHD events occurred. Despite being at very low absolute risk based on traditional CVRF, individuals with 0/1CVRF demonstrated a strong association between increased Lp(a) mass (≥90th pctl.) and future CHD events, which was comparable to the association observed among individuals with ≥2 CVRFs. The fully-adjusted sub-distribution Hazard Ratios [sHRs] for elevated Lp(a) were 1.38 (95% CI, 1.12-1.71) versus 1.27 (95% CI, 1.10-1.46) in those having 0/1 versus ≥2 CVRFs at baseline (Pinteraction0.50).CONCLUSION: Among CHD-free subjects, high Lp(a) was related to adverse outcome even in individuals with no or only one CVRF at baseline, thereby generating substantial challenges in mitigating Lp(a)-associated CHD risk in very low risk populations.
AB - AIMS: Deleterious effects Lipoprotein (a) (Lp(a)) might be mitigated by overall cardiovascular (CV) risk reduction. However, data on the relationship between increased Lp(a) and incident coronary heart disease (CHD) according to the distribution of modifiable CV risk factors (CVRF) at baseline are still scarce. We investigated the association between high Lp(a) and incident CHD in the general population, depending on the presence/absence of four major CVRFs (hypertension, diabetes, hypercholesterolemia, smoking) at baseline.METHODS: Overall 66,495 CHD-free individuals from eight European prospective population-based cohorts were included. The cohort was stratified according to CVRF burden at baseline in "0/1 CVRF" (low risk; n= 41,770) and"≥2 CVRFs" (increased risk; n=24,725). Fine and Gray competing risk-adjusted models were calculated for the association between Lp(a) mass (<90th versus ≥90th percentile (pctl.); cut-off 43.2 mg/dL) and future CHD events.RESULTS: During a median follow-up of 9.7 years, 3,467 incident CHD events occurred. Despite being at very low absolute risk based on traditional CVRF, individuals with 0/1CVRF demonstrated a strong association between increased Lp(a) mass (≥90th pctl.) and future CHD events, which was comparable to the association observed among individuals with ≥2 CVRFs. The fully-adjusted sub-distribution Hazard Ratios [sHRs] for elevated Lp(a) were 1.38 (95% CI, 1.12-1.71) versus 1.27 (95% CI, 1.10-1.46) in those having 0/1 versus ≥2 CVRFs at baseline (Pinteraction0.50).CONCLUSION: Among CHD-free subjects, high Lp(a) was related to adverse outcome even in individuals with no or only one CVRF at baseline, thereby generating substantial challenges in mitigating Lp(a)-associated CHD risk in very low risk populations.
U2 - 10.1093/eurjpc/zwaf340
DO - 10.1093/eurjpc/zwaf340
M3 - Journal article
C2 - 40504886
SN - 2047-4873
JO - European Journal of Preventive Cardiology
JF - European Journal of Preventive Cardiology
ER -