Genetics
Elevated Lp(a) plus a family history of coronary disease nearly doubles MACE risk in 6,056 chronic coronary syndrome patients (J Atheroscler Thromb 2024)
Original title: Joint Association of Lipoprotein(a) and a Family History of Coronary Artery Disease with the Cardiovascular Outcomes in Patients with Chronic Coronary Syndrome
In 6,056 patients with chronic coronary syndrome followed for an average 50.35 months, 378 major adverse cardiovascular events (MACEs) occurred. Elevated Lp(a) independently predicted MACEs both in patients with a family history of coronary artery disease (hazard ratio 2.77, 95% CI 1.38-5.54) and without it (hazard ratio 1.35, 95% CI 1.02-1.77). Compared with patients who had neither elevated Lp(a) nor a positive family history, those with elevated Lp(a) alone had a nominally higher MACE risk (hazard ratio 1.26, 95% CI 0.96-1.67), while those with both elevated Lp(a) and a positive family history had the highest risk (hazard ratio 1.93, 95% CI 1.14-3.28). Adding Lp(a) to the risk model improved the C-statistic by 0.048 in patients with a family history (p = 0.004) but only 0.004 in those without (p = 0.391). This is the first study to show Lp(a) predicts MACEs in chronic coronary syndrome patients regardless of family history, though its prognostic value is considerably stronger when a family history is also present.
Original abstract
Aim: No data are currently available regarding the association between Lp(a) and the cardiovascular outcomes in patients with coronary artery disease (CAD) according to their family history (FHx) of CAD. This study aimed to evaluate the significance of Lp(a) in predicting major adverse cardiovascular events (MACEs) in patients with chronic coronary syndrome (CCS) with or without FHx.
Methods: A total of 6056 patients with CCS were enrolled. Information on FHx was collected, and the plasma Lp(a) levels were measured. All patients were followed up regularly. The independent and joint associations of Lp(a) and FHx with the risk of MACEs, including cardiovascular death, nonfatal myocardial infarction, and stroke, were analyzed.
Results: With over an average of 50.35±18.58 months follow-up, 378 MACEs were recorded. A Cox regression analysis showed an elevated Lp(a) level to be an independent predictor for MACEs in patients with [hazard ratio (HR): 2.77, 95% confidence interval (CI): 1.38-5.54] or without FHx (HR: 1.35, 95% CI: 1.02-1.77). In comparison to subjects with non-elevated Lp(a) and negative FHx, patients with elevated Lp(a) alone were at a nominally higher risk of MACEs (HR: 1.26, 95% CI: 0.96-1.67), while those with both had the highest risk (HR: 1.93, 95% CI: 1.14-3.28). Moreover, adding Lp(a) to the original model increased the C-statistic by 0.048 in subjects with FHx (p=0.004) and by 0.004 in those without FHx (p=0.391).
Conclusions: The present study is the first to suggest that Lp(a) could be used to predict MACEs in CCS patients with or without FHx; however, its prognostic significance was more noteworthy in patients with FHx.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.