Genetics
Ideal cardiovascular health cuts the excess risk from high Lp(a) by two-thirds, the EPIC-Norfolk study of 14,051 adults (Atherosclerosis 2017)
Original title: Ideal cardiovascular health influences cardiovascular disease risk associated with high lipoprotein(a) levels and genotype: The EPIC-Norfolk prospective population study
The EPIC-Norfolk prospective population study stratified 14,051 participants by cardiovascular health score (based on seven American Heart Association metrics: BMI, diet, physical activity, smoking, blood pressure, diabetes and cholesterol) to test whether ideal cardiovascular health mitigates the cardiovascular risk from high Lp(a). Over a mean 11.5-year follow-up, 1732 participants had a cardiovascular event. Serum Lp(a) levels varied little across cardiovascular health categories. Among participants with high Lp(a) (50 mg/dL or above), those in the healthiest cardiovascular health category (score 10-14) had a much lower adjusted hazard ratio for cardiovascular disease (0.33, 95% CI 0.17-0.63, P=0.001) compared with those in the unhealthiest category (score 0-4), with similar results using the rs10455872 genetic variant instead of measured Lp(a). The findings show that while Lp(a) levels are only slightly influenced by cardiovascular health metrics, ideal cardiovascular health can substantially reduce the cardiovascular risk associated with high Lp(a) levels or genotype.
Original abstract
Background And Aims: Lipoprotein(a) (Lp[a]) is a strong genetic risk factor for cardiovascular disease (CVD). The American Heart Association has prioritised seven cardiovascular health metrics to reduce the burden of CVD: body mass index, healthy diet, physical activity, smoking status, blood pressure, diabetes and cholesterol levels (together also known as ideal cardiovascular health). Our objective was to determine if individuals with high Lp(a) levels could derive cardiovascular benefits if characterized by ideal cardiovascular health.
Methods: A total of 14,051 participants of the EPIC-Norfolk study were stratified according to the cardiovascular health score (based on the number of health metrics with an ideal, intermediate or poor status). Of them, 1732 had a CVD event during a mean follow-up of 11.5 years. Cox proportional hazards models were used to describe the association between the cardiovascular health score and Lp(a) level or genotype (as estimated by the rs10455872 variant) with the risk of CVD.
Results: We observed little or no differences in serum Lp(a) levels across the seven cardiovascular health metric categories. Among participants with high serum Lp(a) levels ≥50 mg/dl), those in the highest (i.e. healthiest) cardiovascular health score category (10-14) had an adjusted hazard ratio for cardiovascular disease of 0.33 (95% CI = 0.17-0.63, p = 0.001) compared to participants in the lowest (i.e. unhealthiest) cardiovascular health score category(0-4). Similar results were obtained when we replaced Lp(a) with rs10455872.
Conclusions: Although Lp(a) levels are only slightly influenced by cardiovascular health metrics, an ideal cardiovascular health could substantially reduce CVD risk associated with high Lp(a) levels or genotype.
epidemiologygeneticsrisk prediction
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.