Epidemiology
Mass General Brigham Lp(a) Registry finds diabetes plus elevated Lp(a) drives a nearly eightfold jump in annual cardiac event rate (Cardiovasc Diabetol 2024)
Original title: Lipoprotein(a) as a cardiovascular risk factor among patients with and without diabetes Mellitus: the Mass General Brigham Lp(a) Registry
This retrospective analysis of the Mass General Brigham Lp(a) Registry included 6,238 patients without prior atherosclerotic cardiovascular disease, severe kidney dysfunction, or malignancy who had Lp(a) measured between 2000 and 2019 (median age 54, 45% women, 12% with diabetes). Over a median 12.9-year follow-up, elevated Lp(a) (above the 90th percentile, 216 nmol/L or higher) was associated with higher rates of cardiovascular death or myocardial infarction regardless of diabetes status. Annual event rates rose from 0.6% (no diabetes, lower Lp(a)) to 1.3% (no diabetes, elevated Lp(a)) to 1.9% (diabetes, lower Lp(a)) to 4.7% (diabetes, elevated Lp(a)), P < 0.001. After adjustment, elevated Lp(a) remained independently associated with the primary outcome in both patients with diabetes (hazard ratio 2.66, 95% CI 1.55-4.58) and without (hazard ratio 2.01, 95% CI 1.48-2.74). Elevated Lp(a) is an independent, incremental cardiovascular risk factor whether or not diabetes is present, with the combination of both conditions identifying a markedly higher-risk group.
Original abstract
Background: Diabetes mellitus (DM) and Lp(a) are well-established predictors of coronary artery disease (CAD) outcomes. However, their combined association remains poorly understood.
Objective: To investigate the relationship between elevated Lp(a) and DM with CAD outcomes.
Methods: Retrospective analysis of the MGB Lp(a) Registry involving patients ≥ 18 years who underwent Lp(a) measurements between 2000 and 2019. Exclusion criteria were severe kidney dysfunction, malignant neoplasms, and prior atherosclerotic cardiovascular disease (ASCVD). The primary outcome was a combination of cardiovascular death or myocardial infarction (MI). Elevated Lp(a) was defined as > 90th percentile (≥ 216 nmol/L).
Results: Among 6,238 patients who met the eligibility criteria, the median age was 54, 45% were women, and 12% had DM. Patients with DM were older, more frequently male, and had a higher prevalence of additional cardiovascular risk factors. Over a median follow-up of 12.9 years, patients with either DM or elevated Lp(a) experienced higher rates of the primary outcome. Notably, those with elevated Lp(a) had a higher incidence of the primary outcome regardless of their DM status. The annual event rates were as follows: No-DM and Lp(a) < 90th% - 0.6%; No-DM and Lp(a) > 90th% - 1.3%; DM and Lp(a) < 90th% - 1.9%; DM and Lp(a) > 90th% - 4.7% (p < 0.001). After adjusting for confounders, elevated Lp(a) remained independently associated with the primary outcome among both patients with DM (HR = 2.66 [95%CI: 1.55-4.58], p < 0.001) and those without DM (HR = 2.01 [95%CI: 1.48-2.74], p < 0.001).
Conclusions: Elevated Lp(a) constitutes an independent and incremental risk factor for CAD outcomes in patients with and without DM.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.