Testing
Lp(a) above the 90th decile raises coronary artery disease risk by 62% in routinely tested patients, a 14-year Swedish follow-up of 23,398 people (Eur J Prev Cardiol 2022)
Original title: Plasma lipoprotein(a) measured in the routine clinical care is associated to atherosclerotic cardiovascular disease during a 14-year follow-up
In a retrospective registry study of 23,398 individuals (52% women, mean age 55.5 years, median Lp(a) 17 mg/dL) with Lp(a) measured in routine care at Karolinska University Laboratory (2003-2017), those with Lp(a) above the 90th decile (>90 mg/dL, >180 nmol/L) had higher risk than those at or below the 50th decile: HR 1.25 (95% CI 1.05-1.50, P=0.013) for major adverse cardiovascular events, HR 1.37 (95% CI 1.14-1.64, P=0.001) for atherosclerotic cardiovascular disease, and HR 1.62 (95% CI 1.28-2.05, P<=0.001) for coronary artery disease. No association was found between Lp(a) and mortality, peripheral artery disease, or ischaemic stroke. The findings support the 2019 ESC/EAS recommendation to measure Lp(a) at least once in a lifetime, showing elevated Lp(a) predicts adverse cardiovascular outcomes even when measured opportunistically in routine clinical care.
Original abstract
Aims: To investigate plasma lipoprotein(a) [Lp(a)] levels measured in routine clinical care and their association with mortality and cardiovascular disease.
Methods And Results: This retrospective registry-based observational cohort study includes all individuals with plasma Lp(a) results measured at the Karolinska University Laboratory 2003-17. Outcome data were captured in national outcome registries. Levels of Lp(a) expressed in mass or molar units were examined separately. In adjusted Cox regression models, association between deciles of plasma Lp(a) concentrations, mortality, and cardiovascular outcomes were assessed. A total of 23 398 individuals [52% females, mean (standard deviation) age 55.5 (17.2) years, median Lp(a) levels 17 mg/dL or 19.5 nmol/L] were included. Individuals with an Lp(a) level >90th decile (>90 mg/dL or >180 nmol/L) had hazard ratios (95% confidence interval) of 1.25 (1.05-1.50) for major adverse cardiovascular events (P = 0.013), 1.37 (1.14-1.64) for atherosclerotic cardiovascular disease (P = 0.001), and 1.62 (1.28-2.05) for coronary artery disease (P ≤ 0.001), compared to individuals with Lp(a) ≤50th decile. No association between Lp(a) and mortality, peripheral artery disease, or ischaemic stroke was observed.
Conclusion: High Lp(a) levels are associated with adverse cardiovascular disease outcomes also in individuals with Lp(a) measured in routine clinical care. This supports the 2019 ESC/EAS recommendation to measure Lp(a) at least once during lifetime to assess cardiovascular risk and implies the need for intensive preventive therapy in patients with elevated Lp(a).
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.