Epidemiology
In 16,419 Boston patients followed nearly 12 years, the Lp(a) threshold for elevated MACE risk differs between primary and secondary prevention (J Am Coll Cardiol 2024)
Original title: Lipoprotein(a) and Major Adverse Cardiovascular Events in Patients With or Without Baseline Atherosclerotic Cardiovascular Disease
This retrospective cohort study analysed 16,419 patients with Lp(a) measured at two Boston medical centres between 2000 and 2019, followed for a median 11.9 years, testing whether the Lp(a) threshold for risk assessment should differ by baseline atherosclerotic cardiovascular disease (ASCVD) status. Among the 10,181 patients (62%) with baseline ASCVD, those in the 71st-90th Lp(a) percentile had a 21% higher hazard of major adverse cardiovascular events (adjusted hazard ratio 1.21, P < 0.001), essentially the same as the 91st-100th percentile group (adjusted hazard ratio 1.26, P < 0.001), suggesting risk plateaus earlier in secondary prevention. Among the 6,238 patients without established ASCVD, risk rose continuously with Lp(a), reaching an adjusted hazard ratio of 1.93 (P < 0.001) in the top percentile group. Elevated Lp(a) independently predicts long-term cardiovascular events in both primary and secondary prevention, but the optimal risk threshold may need to be tailored to baseline disease status.
Original abstract
Background: Lipoprotein(a) [Lp(a)] is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). However, whether the optimal Lp(a) threshold for risk assessment should differ based on baseline ASCVD status is unknown.
Objectives: The purpose of this study was to assess the association between Lp(a) and major adverse cardiovascular events (MACE) among patients with and without baseline ASCVD.
Methods: We studied a retrospective cohort of patients with Lp(a) measured at 2 medical centers in Boston, Massachusetts, from 2000 to 2019. To assess the association of Lp(a) with incident MACE (nonfatal myocardial infarction [MI], nonfatal stroke, coronary revascularization, or cardiovascular mortality), Lp(a) percentile groups were generated with the reference group set at the first to 50th Lp(a) percentiles. Cox proportional hazards modeling was used to assess the association of Lp(a) percentile group with MACE.
Results: Overall, 16,419 individuals were analyzed with a median follow-up of 11.9 years. Among the 10,181 (62%) patients with baseline ASCVD, individuals in the 71st to 90th percentile group had a 21% increased hazard of MACE (adjusted HR: 1.21; P < 0.001), which was similar to that of individuals in the 91st to 100th group (adjusted HR: 1.26; P < 0.001). Among the 6,238 individuals without established ASCVD, there was a continuously higher hazard of MACE with increasing Lp(a), and individuals in the 91st to 100th Lp(a) percentile group had the highest relative risk with an adjusted HR of 1.93 (P < 0.001).
Conclusions: In a large, contemporary U.S. cohort, elevated Lp(a) is independently associated with long-term MACE among individuals with and without baseline ASCVD. Our results suggest that the threshold for risk assessment may be different in primary vs secondary prevention cohorts.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.