EpidemiologyLandmark
Lp(a) predicts cardiovascular events in Black and White adults alike: ARIC (Virani et al., Circulation 2012)
Original title: Associations between lipoprotein(a) levels and cardiovascular outcomes in black and white subjects: the Atherosclerosis Risk in Communities (ARIC) Study
In 3,467 Black and 9,851 White participants of the Atherosclerosis Risk in Communities study followed for 20 years, Lp(a) was higher and more widely distributed in Black participants (median 12.8 vs 4.3 mg/dL) and was associated with incident cardiovascular disease, coronary heart disease and ischaemic stroke in both groups, at least as strongly in Black participants. The paper retired the idea that Lp(a) was not a risk factor in people of African ancestry.
Original abstract
Background: On the basis of studies with limited statistical power, lipoprotein(a) [Lp(a)] is not considered a risk factor for cardiovascular disease (CVD) in blacks. We evaluated associations between Lp(a) and incident CVD events in blacks and whites in the Atherosclerosis Risk in Communities (ARIC) study.
Methods And Results: Plasma Lp(a) was measured in blacks (n=3467) and whites (n=9851). Hazards ratios (HRs) for incident CVD events (coronary heart disease and ischemic strokes) were calculated. Lp(a) levels were higher with wider interindividual variation in blacks (median [interquartile range], 12.8 [7.1-21.7] mg/dL) than whites (4.3 [1.7-9.5] mg/dL; P<0.0001). At 20 years of follow-up, 676 CVD events occurred in blacks, and 1821 events occurred in whites. Adjusted HRs (95% confidence interval) per race-specific 1-SD-greater log-transformed Lp(a) were 1.13 (1.04-1.23) for incident CVD, 1.11 (1.00-1.22) for incident coronary heart disease, and 1.21 (1.06-1.39) for ischemic strokes in blacks. For whites, the respective HRs (95% confidence intervals) were 1.09 (1.04-1.15), 1.10 (1.05-1.16), and 1.07 (0.97-1.19). Quintile analyses showed that risk for incident CVD was graded but statistically significant only for the highest compared with the lowest quintile (HR [95% confidence interval], 1.35 [1.06-1.74] for blacks and 1.27 [1.10-1.47] for whites). Similar results were obtained with the use of Lp(a) cutoffs of ≤10 mg/dL, >10 to ≤20 mg/dL, >20 to ≤30 mg/dL, and >30 mg/dL.
Conclusions: Lp(a) levels were positively associated with CVD events. Associations were at least as strong, with a larger range of Lp(a) concentrations, in blacks compared with whites.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.