Testing
A new Lp(a)-inclusive risk calculator recategorised two-thirds of 671 patients upward, but an average 21 mg/dL LDL-C cut could offset most of the added risk (High Blood Press Cardiovasc Prev 2024)
Original title: Impact of Lipoprotein(a) Levels on Cardiovascular Risk Estimation
Using a newly designed cardiovascular risk calculator that incorporates Lp(a), the authors estimated lifetime and 10-year cardiovascular risk in 671 primary-prevention patients (mean age 54.2 years, 47.2% women), of whom 22.7% had high Lp(a) (above 50 mg/dL or 125 nmol/L), both with and without factoring in Lp(a). Incorporating Lp(a) increased lifetime risk estimates in 66.7% of patients (median increase 19.3%), with similar findings for 10-year risk, effectively recategorising two-thirds of patients to a higher risk tier and about one-third to a lower tier. The added risk attributable to Lp(a) could be fully offset by lowering LDL-C by an average 21 mg/dL in 79.2% of cases, or lowering systolic blood pressure by an average 6.3 mmHg in 74.7% of cases. A Lp(a)-inclusive risk score meaningfully reclassifies patients, and the resulting excess risk can often be neutralised through more aggressive, achievable LDL-C or blood pressure targets.
Original abstract
Introduction: A new cardiovascular risk (CVR) calculator that incorporates Lipoprotein(a) [Lp(a)] levels has recently been designed.
Aims: To estimate CVR using the new score and to identify the reduction in low-density lipoprotein cholesterol (LDL-C) or systolic blood pressure (SBP) necessary to balance the risk attributable to Lp(a).
Methods: CVR throughout life and at 10 years was estimated with the new score in patients in primary prevention, both considering and not considering the value of Lp(a). When the estimated risk considering Lp(a) levels exceeded the baseline risk, the reduction in LDL-C levels or SBP necessary to balance the risk attributable to Lp(a) was calculated.
Results: In total, 671 patients (mean age 54.2 years, 47.2% women) were included. Globally, 22.7% of the population had high Lp(a) values (> 50 mg/dL or > 125 nmol/L). When calculating CVR throughout life and considering the Lp(a) value, the global risk increased in 66.7% of cases (median 19.3%). Similar results were observed when we assessed the 10-year risk. The risk associated with Lp(a) could be completely compensated by decreasing LDL-C (average 21 mg/dL) or SBP (average 6.3 mmHg) in 79.2% and 74.7% of cases, respectively.
Conclusion: When calculating the CVR with the new score, two-thirds and one-third of the population were bidirectionally recategorized as 'up' or 'down,' respectively. The decrease in LDL-C or SBP mitigated the increased risk caused by Lp(a) levels across a substantial proportion of patients.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.