Lp(a) predicts heart disease risk in both sexes, with much stronger overall risk prediction in women, the ARIC study of 12,339 people (Circulation 2001)

Original title: Coronary heart disease prediction from lipoprotein cholesterol levels, triglycerides, lipoprotein(a), apolipoproteins A-I and B, and HDL density subfractions: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation · 4 September 2001 · 8

Sharrett AR, Ballantyne CM, Coady SA, Heiss G, Sorlie PD, Catellier D, Patsch W, Atherosclerosis Risk in Communities Study Group

The Atherosclerosis Risk in Communities (ARIC) study followed 12 339 middle-aged participants free of coronary heart disease (CHD) for 10 years, during which 725 CHD events occurred, to determine optimal cholesterol levels and the added predictive value of Lp(a) and other lipids. The lowest CHD incidence occurred at the lowest LDL cholesterol quintile (median 88 mg/dL in women, 95 mg/dL in men), with relative risk rising to 2.7 in women and 2.5 in men at the highest quintile. LDL cholesterol, HDL cholesterol, and Lp(a), plus triglycerides in women only, were independent CHD predictors, giving an overall relative risk of 13.5 in women and 4.9 in men; Lp(a) was less significant in Black than white participants. HDL cholesterol subfractions and apolipoproteins A-I or B did not improve prediction. The findings show optimal LDL cholesterol is below 100 mg/dL in both sexes, with LDL cholesterol, HDL cholesterol, triglycerides and Lp(a) providing substantial CHD prediction, much higher in women than men.

Original abstract

Background: Despite consensus on the need for blood cholesterol reductions to prevent coronary heart disease (CHD), available evidence on optimal cholesterol levels or the added predictive value of additional lipids is sparse.

Methods And Results: After 10 years follow-up of 12 339 middle-aged participants free of CHD in the Atherosclerosis Risk in Communities Study (ARIC), 725 CHD events occurred. The lowest incidence was observed in those at the lowest LDL cholesterol (LDL-C) quintile, with medians of 88 mg/dL in women and 95 mg/dL in men, and risk accelerated at higher levels, with relative risks (RRs) for the highest quintile of 2.7 in women and 2.5 in men. LDL-C, HDL-C, lipoprotein(a) [Lp(a)], and in women but not men, triglycerides (TG) were all independent CHD predictors, providing an RR, together with blood pressure, smoking, and diabetes, of 13.5 in women and 4.9 in men. Lp(a) was less significant in blacks than whites. Prediction was not enhanced by HDL-C density subfractions or apolipoproteins (apo) A-I or B. Despite strong univariate associations, apoB did not contribute to risk prediction in subgroups with elevated TG, with lower LDL-C, or with high apoB relative to LDL-C.

Conclusions: Optimal LDL-C values are <100 mg/dL in both women and men. LDL-C, HDL-C, TG, and Lp(a), without additional apolipoproteins or lipid subfractions, provide substantial CHD prediction, with much higher RR in women than men.

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