Epidemiology
Hegele case series: 16 elderly patients with Lp(a) above 230 nmol/L recorded zero incident cardiovascular events over 8 years (J Int Med Res 2024)
Original title: Elderly patients with very high plasma lipoprotein(a) concentrations and few cardiovascular consequences: a case series
This case series from a lipid clinic identified 16 patients over age 65 with very high Lp(a) (above 230 nmol/L, mean 313 plus/minus 68 nmol/L, mean age 72.2 years at baseline). Over a cumulative 129.0 patient-years of follow-up (mean 8.1 years, reaching mean age 80.3 years), only two patients had a prior history of cardiovascular events, and zero new cardiovascular events occurred during follow-up. The authors conclude that very high Lp(a) and disease-free old age are not mutually exclusive, and that in their aggregated clinical experience the association between elevated Lp(a) and adverse outcomes is only modest, though they still recommend treating modifiable risk factors in these patients. This small case series highlights that elevated Lp(a) does not deterministically predict cardiovascular events in every individual, even at very high concentrations.
Original abstract
Lipoprotein(a) (Lp(a)) is an atherogenic low-density lipoprotein (LDL)-like particle that is currently regarded as a non-modifiable risk factor for atherosclerotic cardiovascular disease. The number of patients detected with elevated Lp(a) concentrations has been increasing in recent years, although the implication of this finding is unclear for patients and physicians. We screened our lipid clinic database for patients aged >65 years with very high Lp(a) concentrations, which were defined as >230 nmol/L, and cardiovascular outcomes were assessed. The patients' (n = 16) mean (±standard deviation) age was 72.2 ± 7.1 years and the mean Lp(a) concentration was 313 ± 68 nmol/L. After a cumulative 129.0 patient-year follow-up (mean: 8.1 ± 4.2 years), the mean age was 80.3 ± 7.0 years. We observed a low baseline prevalence of cardiovascular events, with only two patients having a history of cardiovascular events. Furthermore, zero incident adverse cardiovascular events were recorded over the follow-up. Therefore, very high Lp(a) concentrations and disease-free old age are not mutually exclusive. Our aggregated clinical experience is that there is only a modest association between elevated Lp(a) concentrations and adverse outcomes. Nonetheless, we still advise treating modifiable risk factors in these patients.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.