Epidemiology
Elevated Lp(a) triples recurrent cardiovascular event risk in coronary patients with prediabetes or diabetes, across 5,257 patients (J Endocrinol Invest 2024)
Original title: Lipoprotein(a) is associated with recurrent cardiovascular events in patients with coronary artery disease and prediabetes or diabetes
In 5,257 patients with prior cardiovascular events and established coronary artery disease, stratified into low, medium and high Lp(a) groups and further by glycaemic status, the authors examined recurrent cardiovascular event (CVE) risk over a median 37-month follow-up. Overall, 225 patients (4.28%) had a recurrent CVE, and high Lp(a) was independently associated with recurrence (adjusted hazard ratio 1.57, 95% CI 1.12-2.19, P = 0.008). When stratified by glycaemic status, high Lp(a) carried a substantially greater recurrence risk in patients with prediabetes (adjusted hazard ratio 2.96, 95% CI 1.24-7.05, P = 0.014), while in patients with diabetes, both medium (adjusted hazard ratio 3.09, 95% CI 1.30-7.34, P = 0.010) and high Lp(a) (adjusted hazard ratio 3.13, 95% CI 1.30-7.53, P = 0.011) were associated with increased recurrence risk. Elevated Lp(a) predicts recurrent cardiovascular events in coronary disease patients overall, but its prognostic value is markedly amplified in those with prediabetes or diabetes, supporting its incremental use in risk stratification for this population.
Original abstract
Purpose: Elevated lipoprotein(a) [Lp(a)] and diabetes mellitus (DM) are both associated with adverse events in high-risk patients with established coronary artery disease (CAD). Currently, the association between Lp(a) levels and recurrent cardiovascular (CV) events (CVEs) remained undetermined in patients with different glucose status. Therefore, this study aimed to investigate the prognostic significance of Lp(a) levels for recurrent CVEs in high-risk CAD patients who suffered from first CVEs according to different glycemic metabolism.
Methods: We recruited 5257 consecutive patients with prior CVEs and followed up for recurrent CVEs, including CV death, non-fatal myocardial infarction (MI), and non-fatal stroke. Patients were assigned to low, medium, and high groups according to Lp(a) levels and further stratified by glucose status.
Results: During a median 37-month follow-up, 225 (4.28%) recurrent CVEs occurred. High Lp(a) was independently associated with recurrent CVEs [adjusted Hazard Ratio (HR), 1.57; 95% confidence interval (CI) 1.12-2.19; P = 0.008]. When participants were classified according to Lp(a) levels and glycemic status, high Lp(a) levels were associated with an increased risk of recurrent CVEs in pre-DM (adjusted HR, 2.96; 95% CI 1.24-7.05; P = 0.014). Meanwhile, medium and high Lp(a) levels were both associated with an increased risk for recurrent CVEs in DM (adjusted HR, 3.09; 95% CI 1.30-7.34; P = 0.010 and adjusted HR, 3.13, 95% CI 1.30-7.53; P = 0.011, respectively).
Conclusions: This study demonstrated that elevated Lp(a) levels were associated with an increased recurrent CVE risk in patients with CAD, particularly among those with pre-DM and DM, indicating that Lp(a) may provide incremental value in risk stratification in this population.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.