Epidemiology
Elevated Lp(a) triples acute coronary syndrome risk in adults under 45, but the link fades after 60, a case-control study of 1457 ACS patients (Atherosclerosis 2018)
Original title: High levels of lipoprotein (a) and premature acute coronary syndrome
This case-control study enrolled 1457 patients with a history of acute coronary syndrome (ACS) (mean age 54.8 years, 86% male) and 2090 age- and sex-matched cardiovascular-disease-free adults to test whether Lp(a) associates more strongly with premature ACS. A 10 mg/dL increase in Lp(a) was associated with 4% higher odds of ACS in those under 45 years and 2% higher odds in those 45-60 years. After adjusting for common risk factors, elevated Lp(a) (above 50 mg/dL) remained associated with ACS in those under 45 (odds ratio 2.88, 95% CI 1.7-4.6) and 45-60 years (odds ratio 2.06, 95% CI 1.4-3.2), but not in those over 60 (odds ratio 1.31, 95% CI 0.8-2.4). The findings show Lp(a) is an independent ACS risk factor mainly in younger adults, roughly tripling ACS risk under 45, with the association weakening in middle age and disappearing after 60.
Original abstract
Background And Aims: High levels of lipoprotein(a) [Lp(a)] are associated with increased risk of acute coronary syndrome (ACS). We explored whether Lp(a) exhibits a stronger association with premature ACS.
Methods: A case-control study was conducted; 1457 patients with a history of ACS (54.8 ± 13 years, 86% males) and 2090 age-sex matched adults free of cardiovascular disease were enrolled. Bio-clinical characteristics [risk factors, low-density lipoprotein-cholesterol, Lp(a)] were derived through standard procedures.
Results: A 10 mg/dL increase in Lp(a) was associated with 4% (95% CI, 1.01 to 1.02) higher likelihood of having ACS in younger (<45 years) and 2% (95% CI, 1.01 to 1.02) higher likelihood in middle-aged (45-60 years) individuals. Adjusting for common risk factors, elevated Lp(a), i.e. >50 mg/dL, was still associated with increased likelihood of ACS in younger adults (<45 years) (OR = 2.88, 95% CI, 1.7 to 4.6) and in middle aged ones (45 and 60 years) (OR = 2.06, 95% CI, 1.4 to 3.2), but not in older participants (>60 years) (OR = 1.31, 95% CI, 0.8 to 2.4).
Conclusions: Lp(a) seems to be an independent risk factor for ACS in individuals <45 years, and high Lp(a) levels increase by ∼3folds the risk for ACS. The association is preserved but is less in middle-aged individuals (45-60 years) and is abolished >60 years.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.