Epidemiology
Lp(a) in the top third raises coronary heart disease risk by 60%, a meta-analysis of 27 prospective studies (Circulation 2000)
Original title: Lipoprotein(a) and coronary heart disease. Meta-analysis of prospective studies
This meta-analysis by Danesh, Collins and Peto pooled 27 prospective studies published before 2000, with at least 1 year of follow-up, examining the association between Lp(a) and coronary heart disease (CHD). Across a weighted mean follow-up of 10 years, 5436 CHD deaths or nonfatal myocardial infarctions occurred. Comparing the top third of baseline Lp(a) with the bottom third yielded a combined risk ratio of 1.6 (95% CI 1.4-1.8, P<0.00001), with similar results restricting to 18 general-population studies (risk ratio 1.7, 95% CI 1.4-1.9, P<0.00001). No significant heterogeneity was found among the 18 population-based studies or the 9 studies of patients with prior disease, and Lp(a) was only weakly correlated with classical vascular risk factors, with adjustment for these making little difference to the risk ratios. The findings demonstrate a clear association between Lp(a) and CHD across prospective studies, though the authors note further research is needed to establish causality.
Original abstract
Background: -Studies of the association between the plasma concentration of lipoprotein(a) [Lp(a)] and coronary heart disease (CHD) have reported apparently conflicting findings. We report a meta-analysis of the prospective studies with at least 1 year of follow-up published before 2000.
Methods And Results: The following information was abstracted for each study: geographical location of study, size, type of cohort (population-based or selected because of previous disease), mean age, follow-up duration, blood storage temperature and duration, assay methods, degree of adjustment for potential confounders, and relationship of baseline Lp(a) measurement with subsequent CHD risk. There were 5436 deaths from CHD or nonfatal myocardial infarctions during a weighted mean follow-up of 10 years in the 27 eligible studies. Comparison of individuals in the top third of baseline plasma Lp(a) measurements with those in the bottom third in each study yielded a combined risk ratio of 1.6 (95% CI 1.4 to 1.8, 2P:<0.00001), with similar findings when the analyses were restricted to the 18 studies of general populations (combined risk ratio 1.7, 95% CI 1.4 to 1.9; 2P:<0. 00001). Despite differences among studies in blood storage techniques and assay methods, there was no significant heterogeneity among the results from the 18 population-based studies or among those from the 9 studies of patients with previous disease. Lp(a) was only weakly correlated with classical vascular risk factors, and adjustment for those that had been recorded made little difference to the reported risk ratios.
Conclusions: These prospective studies demonstrate a clear association between Lp(a) and CHD, but further studies are needed to determine the extent to which this is causal.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.