Elevated Lp(a) unexpectedly raises coronary risk in older women just as strongly as in younger men, a cohort of 918 CAD and 829 non-CAD patients (Atherosclerosis 2000)

Original title: Lipoprotein(a) associated with coronary artery disease in older women: age and gender analysis

Atherosclerosis · 1 December 2000 · 7

Foody JM, Milberg JA, Pearce GL, Sprecher DL

This cross-sectional study measured baseline Lp(a) in 918 coronary artery disease (CAD) patients and 829 non-CAD patients (603 women, 1144 men) at an outpatient prevention clinic, to examine age and sex differences in Lp(a)-associated CAD risk. Elevated Lp(a) (above 30 mg/dL) was a significant risk factor in both men and women (odds ratio 1.9 each). In men 55 or younger, CAD prevalence rose from 32% to 61% as Lp(a) rose from 5 mg/dL or below to 45 mg/dL or above (P for trend<0.001, odds ratio 2.5), with no significant association in men over 55. In women, CAD risk rose from 22% to 35% in those 55 or younger, and from 38% to 63% in women over 55 (odds ratio 2.1). Both younger men and older women showed substantial risk at Lp(a) above 45 mg/dL (odds ratio 3.7 and 3.3, respectively). The findings show a newly identified Lp(a)-related risk in older women comparable to that in younger men.

Original abstract

Background: Lipoprotein (a) has been associated with increased coronary artery disease (CAD) risk in men, but relatively little data exists in women. While age influences the cardiovascular risk associated with Lp(a) in men, little is known about this phenomenon in women. The impact of gender on Lp(a) has not been fully studied in an ongoing clinical practice.

Methods And Results: Baseline Lp(a) values were measured in 918 CAD and 829 non-CAD patients (603 females, 1144 males) entering an outpatient prevention clinic. The age-specific association of elevated Lp(a) (> 30 mg/dl) with CAD was examined after adjustment for traditional risk factors. Lp(a) was a significant risk factor (OR = 1.9, CI, 1.4-2.6) in men and women (OR = 1.9, CI 1.3-2.9). In men age < or = 55 years the odds ratio for increased cardiovascular risk in high vs low Lp(a) was 2.5 (CI 1.6-3.9). In men < or = 55, CAD increased from 32 to 61% as Lp(a) progressively rose from < or = 5 to > or = 45 mg/dl (P value for trend < 0.001). No significant increase was observed in men > 55 years (OR = 1.3, CI 0.9-2.1). In women < or = 55 years, the risk of CAD increased from 22 to 35% (OR 1.6, CI 0.8-3.2), and increased from 38 to 63% in women > 55 (OR 2.1, CI 1.3-3.5). Further, of high-risk patients (men < or = 55 and women > 55 years) with an Lp(a) in the range of 20-44 mg/dl (third quartile), younger men showed a greater incidence of CAD (51%) than older women (43%). Both genders revealed substantial risk when the Lp(a) values were above 45 mg/dl. (OR = 3.7, CI = 2.0-6.8 in younger men; OR = 3.3, CI = 1.6-6.6 in older women).

Conclusions: In this cross sectional study of both men and women, elevated Lp(a) was associated with a significantly increased risk of CAD in men and women. While we corroborate previous reports on the lack of association in older men, the determination of an enhanced Lp(a)-related risk in older women was new and unanticipated. Further, in this population of high risk patients, substantial cardiovascular risk appeared to be represented by higher concentrations of Lp(a) in women than observed in men.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.