Epidemiology
Persistently high Lp(a) from admission to one year raises MACCE risk 87% after heart attack, 1,131-patient trajectory study finds (Ann Med 2025)
Original title: Persistent lipoprotein(a) exposure and its association with clinical outcomes after acute myocardial infarction: a longitudinal cohort study
This longitudinal cohort study followed 1,131 acute myocardial infarction (AMI) patients, measuring Lp(a) at admission and again at one year and classifying them by a 300 mg/L threshold into persistent low, fortified (low to high), attenuated (high to low), and persistent high Lp(a) trajectory groups. Over a median 50-month follow-up, 343 patients (35.70%) had a major adverse cardiovascular and cerebrovascular event (MACCE) and 210 (18.70%) died, 126 (11.20%) from cardiovascular causes. Compared with the persistent low Lp(a) group, the persistent high Lp(a) group had significantly higher adjusted risk of MACCE (HR 1.871, 95% CI 1.474-2.374), non-fatal stroke (HR 1.647, 95% CI 1.031-2.632), unplanned revascularisation (HR 1.571, 95% CI 1.008-2.449), all-cause death (HR 1.546, 95% CI 1.134-2.108), and cardiovascular death (HR 2.163, 95% CI 1.405-3.331). Tracking Lp(a) over time, not just at a single point, sharpens post-AMI risk stratification.
Original abstract
Aims: To assess the link between persistent lipoprotein(a) [Lp(a)] exposure levels and clinical outcomes in patients with acute myocardial infarction (AMI).
Methods: This longitudinal cohort study included 1131 AMI patients, categorizing persistent Lp(a) exposure based on measurements at admission and after 1 year. Patients were segmented into four groups using a 300 mg/L Lp(a) threshold: (1) persistent low Lp(a) (lowon admission - lowat 1 year); (2) fortified Lp(a) (lowon admission - highat 1 year); (3) attenuated Lp(a) (highon admission - lowat 1 year); and (4) persistent high Lp(a) (highon admission - highat 1 year). Multivariate Cox regression, subgroup analysis and sensitivity analysis assessed the association between Lp(a) trajectories and major adverse cardiovascular and cerebrovascular events (MACCE), cardiovascular death, non-fatal MI, non-fatal stroke, unplanned revascularization, and all-cause death.
Results: Over a median 50-month follow-up, 343 (35.70%) patients encountered MACCE, and 210 (18.70%) died, including 126 (11.20%) from cardiovascular causes. The group with persistent high Lp(a) faced increased risk of MACCE (HRadjusted, 1.871; 95% CI: 1.474-2.374), non-fatal stroke (HRadjusted, 1.647; 95% CI: 1.031-2.632), unplanned revascularization (HRadjusted, 1.571; 95% CI: 1.008-2.449), and both all-cause (HRadjusted, 1.546; 95% CI: 1.134-2.108) and cardiovascular death (HRadjusted, 2.163; 95% CI: 1.405-3.331), compared to the persistent low Lp(a) group.
Conclusions: In AMI patients, sustained high Lp(a) levels were significantly associated with increased risk of MACCE, non-fatal stroke, unplanned revascularization, and both all-cause and cardiovascular death.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.