Lp(a) predicts coronary disease and its severity across ethnicities, highest in Asian Indians, in a multi-ethnic study of 2,025 Southeast Asian patients (Atherosclerosis 2022)

Original title: Lipoprotein(a) as predictor of coronary artery disease and myocardial infarction in a multi-ethnic Asian population

Atherosclerosis · 26 November 2021 · 7

Loh WJ, Chang X, Aw TC, Phua SK, Low AF, Chan MY, Watts GF, Heng CK

In 2,025 patients (94.5% men, 61.4% Chinese ethnicity) undergoing coronary angiography, median Lp(a) was highest in those with coronary artery disease (CAD) and prior myocardial infarction (26.2 nmol/L), intermediate in CAD without infarction (20.1 nmol/L), and lowest in minimal CAD (15.8 nmol/L), with Lp(a) >=120 nmol/L following the same pattern (11.8%, 9.1%, 2.4% respectively). Lp(a) levels were highest in Asian Indians, followed by Malays and Chinese patients (P<0.001). Lp(a) independently predicted CAD (OR 1.12 per 10 nmol/L increment, P<0.001; OR 5.41 for Lp(a) >=120 nmol/L, P=0.004) and, among CAD patients, predicted acute myocardial infarction risk (OR 1.02 per 10 nmol/L increment, P=0.024) and was positively associated with CAD severity (P=0.020) at Lp(a) >=120 nmol/L. The findings confirm Lp(a) as a positive predictor of coronary disease and its severity in a multi-ethnic Southeast Asian population, with clear ethnic variation in baseline levels.

Original abstract

Background And Aims: The role of Lp(a) in multi-ethnic Asian populations with coronary artery disease (CAD) has not been well established. The aims of this study were (i) to investigate whether Lp(a) is a predictor of CAD, and (ii) amongst patients with CAD, to ascertain whether Lp(a) is a predictor of acute myocardial infarction (AMI) and severity of CAD.

Methods: We compared three cardiovascular phenotypes from patients recruited at coronary angiography. CAD was defined as ≥50% coronary artery stenosis and subdivided into a group with AMI history (CAD+AMI+) and a group without (CAD+AMI-). Minimal CAD group (CAD-) was defined as normal or <30% coronary artery stenosis and no AMI. The severity of CAD was defined using the modified Gensini score.

Results: We studied 2025 patients comprising 94.5% men and 61.4% of Chinese ethnicity. The median Lp(a) level was highest in CAD+AMI+, followed by CAD+AMI- and CAD- (26.2, 20.1, and 15.8 nmol/L respectively). Similarly, the frequency of patients with Lp(a) ≥120 nmol/L were in the same order (11.8%, 9.1% and 2.4%). Lp(a) levels were highest among Asian Indians, followed by Malays and Chinese patients (p < 0.001). Lp(a) levels and Lp(a) ≥120 nmol/L were significant predictors of CAD (Odds ratio (OR) = 1.12 per 10 nmol/L increment, p < 0.001, and OR = 5.41 p = 0.004 respectively). Among patients with CAD, higher Lp(a) levels were associated with increased AMI risk (OR = 1.02 per 10 nmol/L increment, p = 0.024). Lp(a) ≥120 nmol/L was positively associated with CAD severity (p = 0.020).

Conclusions: Plasma Lp(a) concentration is a positive predictor of CAD and AMI in a mostly male South East Asian population.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.