Epidemiology
Lp(a) predicts heart disease risk in secondary prevention only when LDL cholesterol is elevated, a meta-analysis of 18,978 patients (J Am Coll Cardiol 2014)
Original title: Lipoprotein(a) for risk assessment in patients with established coronary artery disease
This study assessed Lp(a) prognostic value in patients with established coronary artery disease (CAD), measuring Lp(a) in 6,708 subjects from 3 new studies and combining these with 8 previously published studies for a total of 18,978 subjects. In the 3 new studies alone, Lp(a) was not associated with cardiovascular events as a continuous variable (odds ratio 1.03 per log-SD, 95% CI 0.96-1.11) or by quintile (odds ratio 1.05, 95% CI 0.83-1.34). Combined with prior studies, the highest Lp(a) quantile carried increased cardiovascular risk (odds ratio 1.40, 95% CI 1.15-1.71), though with significant heterogeneity (P=0.001). Stratifying by LDL cholesterol, the Lp(a)-event association was significant in studies with average LDL cholesterol at or above 130 mg/dL (odds ratio 1.46, 95% CI 1.23-1.73, P<0.001) but not in studies below 130 mg/dL (odds ratio 1.20, 95% CI 0.90-1.60, P=0.21). The findings show Lp(a) significantly predicts cardiovascular risk in established CAD, though its prognostic value in patients with low LDL cholesterol remains unclear.
Original abstract
Objectives: The purpose of this study was to assess the prognostic utility of lipoprotein(a) [Lp(a)] in individuals with coronary artery disease (CAD).
Background: Data regarding an association between Lp(a) and cardiovascular (CV) risk in secondary prevention populations are sparse.
Methods: Plasma Lp(a) was measured in 6,708 subjects with CAD from 3 studies; data were then combined with 8 previously published studies for a total of 18,978 subjects.
Results: Across the 3 studies, increasing levels of Lp(a) were not associated with the risk of CV events when modeled as a continuous variable (odds ratio [OR]: 1.03 per log-transformed SD, 95% confidence interval [CI]: 0.96 to 1.11) or by quintile (Q5:Q1 OR: 1.05, 95% CI: 0.83 to 1.34). When data were combined with previously published studies of Lp(a) in secondary prevention, subjects with Lp(a) levels in the highest quantile were at increased risk of CV events (OR: 1.40, 95% CI: 1.15 to 1.71), but with significant between-study heterogeneity (p = 0.001). When stratified on the basis of low-density lipoprotein (LDL) cholesterol, the association between Lp(a) and CV events was significant in studies in which average LDL cholesterol was ≥130 mg/dl (OR: 1.46, 95% CI: 1.23 to 1.73, p < 0.001), whereas this relationship did not achieve statistical significance for studies with an average LDL cholesterol <130 mg/dl (OR: 1.20, 95% CI: 0.90 to 1.60, p = 0.21).
Conclusions: Lp(a) is significantly associated with the risk of CV events in patients with established CAD; however, there exists marked heterogeneity across trials. In particular, the prognostic value of Lp(a) in patients with low cholesterol levels remains unclear.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.