Testing
Advanced liver fibrosis from NASH lowers Lp(a) levels, undermining its value as a cardiovascular risk marker in 176 patients (Atherosclerosis 2020)
Original title: Advanced fibrosis of non-alcoholic steatohepatitis affects the significance of lipoprotein(a) as a cardiovascular risk factor
In 176 patients with biopsy-proven non-alcoholic fatty liver disease, serum Lp(a) levels were lower in those with advanced fibrosis (stage 3-4) than those with non-advanced fibrosis (stage 0-2, P<0.05), and this inverse association persisted after adjustment for age, sex, body mass index, ALT, creatinine, HbA1c, HDL cholesterol, LDL cholesterol, triglycerides and lipid-lowering therapy (P<0.01). Lp(a) was also inversely associated with NAFLD Activity Score of 5-8, though this association lost significance after the same adjustments. The findings suggest advanced NASH lowers Lp(a) independent of standard cardiovascular risk factors, which may limit the usefulness of Lp(a) measurement for cardiovascular risk assessment in patients with advanced liver fibrosis.
Original abstract
Background And Aims: Lipoprotein(a) [Lp(a)] is an important independent cardiovascular risk factor. However, Lp(a) levels are lower in patients with chronic liver disease than in healthy subjects. Furthermore, Lp(a) levels decrease as residual liver function declines. Although non-alcoholic fatty liver disease (NAFLD), especially advanced non-alcoholic steatohepatitis (NASH), increases the risk of cardiovascular diseases, the relationship between serum Lp(a) level and NASH is unknown. Thus, we examined the relationship between serum Lp(a) levels and biopsy-proved NAFLD and clarified the significance of Lp(a) measurements for cardiovascular disease screening in patients with NAFLD.
Methods: A total of 176 patients with NAFLD were enrolled. Comprehensive blood chemistry tests and histological examinations of liver samples were conducted. The relationship between serum Lp(a) levels and NAFLD was analyzed.
Results: Serum Lp(a) levels in advanced fibrosis (stage 3-4) were lower than those in non-advanced fibrosis (stage 0-2) (p < 0.05). After adjustment for age, sex, body mass index, alanine aminotransferase (ALT), creatinine (Cre), HbA1c level, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and the use of lipid-lowering agents, the significant inverse association between advanced fibrosis and serum Lp(a) levels remained (p < 0.01). Although the Lp(a) level was inversely associated with an NAFLD Activity Score (NAS) of 5-8, there was no significant association between Lp(a) levels and NAS adjusted for age, sex, body mass index, ALT, Cre, HbA1c level, HDL-C, LDL-C, TG, and the use of lipid-lowering agents.
Conclusions: Advanced NASH is associated with low serum Lp(a) levels; therefore, Lp(a) levels may not be useful in evaluating cardiovascular risk.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.