Genetics
Lp(a) of 180 mg/dL carries the same heart attack risk as genetically diagnosed familial hypercholesterolaemia, in 69,644 Danes followed 42 years (J Am Coll Cardiol 2022)
Original title: Equivalent Impact of Elevated Lipoprotein(a) and Familial Hypercholesterolemia in Patients With Atherosclerotic Cardiovascular Disease
In the Copenhagen General Population Study (69,644 individuals followed up to 42 years; 4,166 developed myocardial infarction, 11,464 developed atherosclerotic cardiovascular disease), the authors determined which Lp(a) level carries equivalent myocardial infarction and ASCVD risk to clinically or genetically diagnosed familial hypercholesterolaemia (FH). For myocardial infarction, the equivalent Lp(a) level ranged from 67 mg/dL (MEDPED criteria) to 402 mg/dL (probable/definite Dutch Lipid Clinic Network criteria), and was 180 mg/dL for genetically defined FH; for ASCVD, equivalent levels ranged from 130 to 391 mg/dL across clinical criteria, and 175 mg/dL for genetic FH. Individuals with both elevated Lp(a) and FH or family history of premature myocardial infarction had markedly higher risk than those with only one trait, with the highest Lp(a) quintile carrying a hazard ratio of 14.0 for myocardial infarction (95% CI 9.15-21.3) and 5.05 for ASCVD (95% CI 3.41-7.48) versus the lowest half. The findings quantify, for the first time in one population, the Lp(a) level equivalent to FH-level genetic cardiovascular risk.
Original abstract
Background: Genetically elevated plasma lipoprotein(a) and familial hypercholesterolemia each result in premature atherosclerotic cardiovascular disease (ASCVD); however, a direct comparison in the same population is needed of these 2 genetic traits on the risk of ASCVD.
Objectives: We determined the level of plasma lipoprotein(a) that is equivalent to low-density lipoprotein (LDL) cholesterol in clinically and genetically diagnosed familial hypercholesterolemia on risk of myocardial infarction and ASCVD.
Methods: We examined the CGPS (Copenhagen General Population Study) with determination of lipoprotein(a) and familial hypercholesterolemia in 69,644 individuals followed for 42 years, during which time, 4,166 developed myocardial infarction and 11,464, ASCVD.
Results: For risk of myocardial infarction, the plasma lipoprotein(a) level equivalent to LDL cholesterol in clinical familial hypercholesterolemia was 67 mg/dL (142 nmol/L) for MEDPED (Make Early Diagnosis to Prevent Early Death), 110 mg/dL (236 nmol/L) for Simon Broome, 256 mg/dL (554 nmol/L) for possible DLCN (Dutch Lipid Clinic Network), and 402 mg/dL (873 nmol/L) for probable+definite DLCN, whereas it was 180 mg/dL (389 nmol/L) for genetic familial hypercholesterolemia. Corresponding values for ASCVD were 130 mg/dL (280 nmol/L), 150 mg/dL (323 nmol/L), 227 mg/dL (491 nmol/L), 391 mg/dL (849 nmol/L), and 175 mg/dL (378 nmol/L), respectively. Individuals with both elevated lipoprotein(a) and either familial hypercholesterolemia or a family history of premature myocardial infarction had a higher risk of myocardial infarction and ASCVD compared with individuals with only 1 of these genetic traits, with the highest HRs being for lipoprotein(a) upper 20% vs lower 50% of 14.0 (95% CI: 9.15-21.3) for myocardial infarction and 5.05 (95% CI: 3.41-7.48) for ASCVD.
Conclusions: Lipoprotein(a) levels equivalent to LDL cholesterol in clinical and genetic familial hypercholesterolemia were 67 to 402 mg/dL and 180 mg/dL, respectively, for myocardial infarction and 130 to 391 mg/dL and 175 mg/dL, respectively, for ASCVD.
familial hypercholesterolaemiageneticsrisk prediction
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.