Epidemiology
Lp(a) predicts cardiovascular events specifically in very-high-risk ASCVD patients, not lower-risk ones, in 9,944 Chinese patients (MedComm 2024)
Original title: Prognostic role of lipoprotein(a) in atherosclerotic cardiovascular disease risk from a perspective on current risk stratification
In a cohort of 9,944 Chinese patients with atherosclerotic cardiovascular disease (ASCVD), stratified into very-high-risk (VHR) and non-VHR subgroups per current guidelines, Lp(a) rose with increasing ASCVD risk category. Over an average 38.5-month follow-up, cardiovascular events rose significantly with Lp(a) gradient in the VHR subgroup but not in the non-VHR subgroup. Compared with Lp(a) below 30 mg/dL, Lp(a) at or above 75 mg/dL carried an adjusted hazard ratio of 1.75 (95% CI 1.25-2.46) for cardiovascular events overall, rising to 2.18 (95% CI 1.32-3.58) in the VHR subgroup but only 1.43 (95% CI 0.93-2.18, not significant) in the non-VHR subgroup. At the highest Lp(a) percentile grade (90th or above), hazard ratios were 1.72 overall, 2.83 in VHR, and 1.38 (not significant) in non-VHR. Lp(a) appears to contribute disproportionately more to cardiovascular risk in patients already classified as very-high-risk, suggesting its prognostic value is concentrated in this subgroup for risk-stratification purposes.
Original abstract
Lipoprotein(a) [Lp(a)] is an emerging predictor for atherosclerotic cardiovascular disease (ASCVD) but the association from a perspective on current risk stratification was unknown. A cohort of 9944 Chinese patients with ASCVD was recruited and refined into very-high-risk (VHR) and non-VHR subgroups according to current guideline. Lp(a) plasma levels were divided by its concentration (<30, 30-50, 50-75, and ≥75 mg/dL) and percentile zones (<25th, 25-50th, 50-75th, 75-90th, ≥90th). Cardiovascular events (CVEs) occurred during an average of 38.5 months' follow-up were recorded. We found that Lp(a) was increased with risk stratification of ASCVD increasing. Prevalence of CVEs had a significantly increasing trend with gradients of Lp(a) elevation in VHR but not in non-VHR subgroup. The adjusted HRs (95%CIs) for CVEs were 1.75(1.25-2.46) in the highest group of Lp(a) ≥75 mg/dL compared with the group of Lp(a) <30 mg/dL as the reference in overall patients, 2.18(1.32-3.58) in VHR subgroup and 1.43(0.93-2.18) in non-VHR subgroup, respectively. The adjusted HRs (95%CIs) at the highest grade of Lp(a) levels (≥90th) were 1.72(1.19-2.50) in overall population, 2.83(1.53-5.24) in VHR subgroup and 1.38(0.86-2.12) in non-VHR subgroup, respectively. These findings suggested that Lp(a) might contribute more to CVEs risk in VHR subgroup of ASCVD.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.