Epidemiology
High Lp(a) predicts carotid atherosclerosis but not all-cause mortality over nearly three decades of follow-up, Toulouse cohort of 11,990 finds (Am J Prev Cardiol 2025)
Original title: Association of high lipoprotein (a) level with carotid atherosclerosis and all-cause mortality
This retrospective analysis examined 11,990 subjects who underwent at least one Lp(a) measurement at the preventive cardiology department of Toulouse University Hospital, Rangueil, between September 1995 and December 2023, with living status assessed through March 2024. The high-Lp(a) group (50 mg/dL or 125 nmol/L or above, n = 3,195) included significantly more women (47.5% vs. 41.4%), non-obese (89.1% vs. 84.7%), physically active (71% vs. 68.1%) and normotensive (70.5% vs. 67.6%) participants than the normal-Lp(a) group. Adjusted logistic regression found high Lp(a) positively associated with atherogenic carotid Doppler ultrasound findings (adjusted OR 1.308, 95% CI 1.182-1.447, P = 0.001). Over 13 years of mortality follow-up, all-cause mortality was comparable between groups (7.4% vs. 8%), with no significant survival difference by Kaplan-Meier (P = 0.643) or Cox regression (HR 0.981, 95% CI 0.844-1.141, P = 0.811). The authors conclude long-term high Lp(a) exposure predicts atherosclerotic disease but not death from any cause, in one of the longest single-centre Lp(a) follow-up cohorts reported.
Original abstract
Background: Lipoprotein (a) Lp(a) is a genetically inherited low-density lipoprotein like particle with proinflammatory, prothrombotic and proatherogenic properties. Current guidelines recommend at least one-time measurement of Lp(a) in cardiovascular risk assessment in each adult person's lifetime.
Aims: The present study evaluates the association between exposure to a high circulating level of Lp(a) (≥50mg/dl or ≥125nmol/L) and atherosclerosis and all-cause of death after a very long-term follow-up.
Methods: A retrospective analysis was performed on 11,990 subjects admitted to the department of preventive cardiology at Toulouse University Hospital, Rangueil, France and who underwent at least one Lp (a) measurement between September 1995 and December 2023. The living status (alive or dead) of each of study's participants was assessed by March 2024. The study population was divided into two groups: first, according to Lp (a) level (normal versus high circulating Lp (a) level), and second, according to the living status.
Results: High-Lp(a) level group includes 3195 participants. They were significantly more women (47.5 % vs.41.4 %), non-obese (89.1 % vs.84.7 %), sportier (71 % vs. 68.1 %) and normotensive (70.5 % vs. 67.6 %). The adjusted logistic regression on traditional cardiovascular risk factors reveal a positive association between High Lp(a) level and atherogenic findings on doppler ultrasound of carotid arteries [ORa = 1.308;95 %CI(1.182-1.447), p = 0.001]. The all-cause mortality rate was comparable between the two study groups over 13 years of follow-up (7.4 % vs. 8 %). Survival analyses with Kaplan-Meier curves (p = 0.643) and Cox regression [HR = 0.981, 95 %CI (0.844-1.141), p = 0.811] showed no significant difference in survival outcomes.
Conclusion: Long-term exposure to high Lp(a) is a predictor for atherosclerotic cardiovascular disease, but not significantly associated with risk of death from any cause.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.