Epidemiology
Lp(a) predicts additional cardiovascular risk in people with diabetes or prediabetes, the ARIC study of 9,871 adults (Atherosclerosis 2019)
Original title: Lipoprotein(a) levels and risk of cardiovascular disease events in individuals with diabetes mellitus or prediabetes: The Atherosclerosis Risk in Communities study
The Atherosclerosis Risk in Communities (ARIC) study measured Lp(a) at baseline (1996-1998) in 9871 participants (mean age 63 years, 5816 women, 2155 African Americans) without prior cardiovascular disease, of whom 1543 had diabetes and 3615 had prediabetes, and followed them for about 15 years. Cumulative cardiovascular event incidence was higher in participants with diabetes (26%) or prediabetes (13%) than in those without (10%, P<0.001). Comparing the highest (50 mg/dL or above) to lowest (10 mg/dL or below) Lp(a) categories, higher Lp(a) was significantly associated with increased cardiovascular events in Caucasian participants with prediabetes (hazard ratio 1.35, 95% CI 1.07-1.69, P=0.03) and diabetes (hazard ratio 1.42, 95% CI 1.10-1.84, P<0.01), but not in those with normal glucose. Adding Lp(a) to standard risk equations improved risk prediction in both diabetes and prediabetes groups. The findings support measuring Lp(a) in people with diabetes or prediabetes, despite current guidelines not recommending it in this population.
Original abstract
Background And Aims: Diabetes increases risk for atherosclerotic cardiovascular disease (ASCVD). Current guidelines do not recommend measuring lipoprotein(a), another ASCVD risk factor, in these individuals. We examined the association of lipoprotein(a) levels with incident ASCVD events in persons with and without diabetes or prediabetes.
Methods: Lipoprotein(a) and other ASCVD risk factors were measured at baseline (1996-1998) in the biracial Atherosclerosis Risk in Communities study; participants without prevalent ASCVD (coronary heart disease or stroke) were monitored ∼15 years for incident ASCVD events.
Results: Of 9871 eligible participants (mean age 63 years; 5816 women; 2155 African Americans), 1543 had diabetes and 3615 had prediabetes. Cumulative ASCVD incidence rates (event/1000-person years) were higher in participants with diabetes (26%) or prediabetes (13%) than in nondiabetic individuals (10%, p < 0.001). When comparing highest to lowest lipoprotein(a) categories (≥50 mg/dL vs. ≤10 mg/dL), increasing lipoprotein(a) levels were significantly associated with increasing incident ASCVD events in Caucasian participants with prediabetes (hazard ratio [HR] = 1.35; 95% confidence interval [CI] 1.07-1.69); p = 0.03) and diabetes (HR = 1.42; 95% CI 1.10-1.84; p < 0.01), but not those with normal fasting blood glucose. Adding lipoprotein(a) to Pooled Cohort Equation variables improved risk prediction in persons with diabetes (Δ in area under the receiver operating characteristic curve [AUC] 0.0087, net reclassification index [NRI] 0.1761) and prediabetes (ΔAUC 0.0025, NRI 0.0938).
Conclusions: In this biracial cohort, elevated lipoprotein(a) levels in Caucasian individuals with diabetes or prediabetes were associated with further increased ASCVD risk. Adding lipoprotein(a) to traditional risk factors improved ASCVD risk prediction.
diabetesepidemiologyrisk prediction
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.