Epidemiology
Lp(a) value for predicting recurrent events in secondary prevention remains inconsistent, a critical appraisal addressing index event bias (J Clin Lipidol 2018)
Original title: Lipoprotein(a) and secondary prevention of atherothrombotic events: A critical appraisal
This critical appraisal by Boffa, Stranges, Klar, Moriarty, Watts and Koschinsky examines whether elevated Lp(a) predicts atherothrombotic events in patients with pre-existing cardiovascular disease, a secondary prevention question distinct from Lp(a) well-established role in predicting first events in large population studies. The authors find inconsistent findings across studies investigating Lp(a) in secondary prevention, despite guidelines recommending Lp(a) screening in this population as a potential target for emerging Lp(a)-lowering therapies. The review identifies possible confounding factors behind the inconsistent findings, including index event bias, where selecting only patients who already had an event distorts the apparent relationship between a risk factor and subsequent events.
Original abstract
Elevated plasma concentrations of lipoprotein(a) [Lp(a)] are an independent, and possibly causal, risk factor for atherothrombotic diseases including coronary heart disease. The principal evidence base for this comes from large population studies focusing on first atherothrombotic events. However, inconsistent findings have been reported from studies investigating the impact of elevated Lp(a) on atherothrombotic events in subjects with preexisting cardiovascular disease. This question is very important because the secondary prevention population is recommended for Lp(a) screening by some guidelines and could be an important target group for Lp(a)-lowering therapies that are currently on the horizon. In this review, we survey the secondary prevention literature as it relates to Lp(a) and identify some possible confounding factors that may underlie the inconsistent findings, such as index event bias.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.