Epidemiology
Lp(a) at or above 70 nmol/L on admission nearly doubles two-year mortality in 520 hospitalised ischaemic heart disease patients (Front Endocrinol 2025)
Original title: Lipoprotein(a) as a predictor of mortality in hospitalised patients with ischaemic heart disease
In a prospective observational cohort of 520 consecutively recruited multi-ethnic Asian patients hospitalised with ischaemic heart disease (half with acute myocardial infarction, median age 63.5 years, 82.3% male, median Lp(a) 35.2 nmol/L), baseline Lp(a) at or above 70 nmol/L was associated with increased two-year risk of all-cause mortality (hazard ratio 1.97, 95% CI 1.20-3.22, p = 0.007) and cardiovascular mortality (hazard ratio 2.01, 95% CI 1.06-3.82, p = 0.033) on multivariable Cox regression, though not significantly with major adverse cardiovascular events (hazard ratio 1.29, 95% CI 0.98-1.7, p = 0.067). Higher natural log-transformed Lp(a) also predicted all-cause mortality (hazard ratio 1.25, 95% CI 1.01-1.58, p = 0.042). Over the two-year follow-up, 14.6% of patients died of any cause, 8.5% of cardiovascular causes, and 49.2% had a major adverse cardiovascular event. The findings support routine Lp(a) evaluation in hospitalised high cardiovascular risk patients, extending prior population-level evidence to the acute hospital setting.
Original abstract
Background: Elevated Lipoprotein(a) [Lp(a)] increases the risk of cardiovascular disease and mortality in population studies but reports of whether elevated Lp(a) concentration predicts mortality in hospitalised patients with cardiovascular disease are still lacking and conflicting.
Aim: To investigate whether elevated Lp(a) predicted cardiovascular outcomes in patients with ischaemic heart disease (IHD) admitted to hospital.
Methods: Serum Lp(a) concentrations were measured in 520 consecutively recruited patients admitted to hospital with IHD, half of whom had an acute myocardial infarction. Patients with elevated Lp(a) at baseline were compared with patients with non-elevated Lp(a). In this observational prospective cohort study, multivariable Cox proportional hazards regression was used to assess the association of baseline Lp(a) with hazard rates (HR) of mortality and major adverse cardiovascular events (MACE).
Results: During the 2-year follow-up period, 14.6%, 8.5%, and 49.2% of patients had all-cause mortality, cardiovascular mortality, and MACE respectively. Median age was 63.5 years, 82.3% were male and the median Lp(a) was 35.2 nmol/L. Multivariable Cox regression showed baseline Lp(a) ≥70 nmol/L was associated with increased risk of all-cause mortality (HR 1.97 [1.20-3.22], p=0.007) and cardiovascular mortality (HR 2.01 [1.06-3.82], p=0.033), but was not statistically significant for MACE (HR 1.29 [0.98-1.7], p=0.067). Higher natural log-transformed Lp(a) concentrations predicted all-cause mortality (HR 1.25 [1.01-1.58], p=0.042) but not for cardiovascular mortality or MACE.
Conclusion: In a multi-ethnic Asian patient cohort, elevated Lp(a) concentrations ≥70 nmol/L at hospitalization positively predicted cardiovascular and all-cause mortality in patients with ischaemic heart disease. Our findings support guidelines' recommendation for routine evaluation of Lp(a) in all patients at high cardiovascular risk.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.