An optimal Life's Simple 7 score cuts ASCVD risk regardless of Lp(a) level, MESA cohort of 6,676 finds, but elevated Lp(a) still carries higher absolute risk at every lifestyle score (Eur J Prev Cardiol 2025)

Original title: Traditional risk factors, optimal cardiovascular health, and elevated lipoprotein(a)

Eur J Prev Cardiol · 14 July 2025 · 7

Razavi AC, Reyes MP, Wilkins JT, Szklo MS, Tsai MY, Whelton SP, Sperling LS, Tsimikas S, Bhatia HS

This analysis of the Multi-Ethnic Study of Atherosclerosis (MESA) followed 6,676 participants without clinical ASCVD (mean age 62.1 years, 53% women, 61% non-white) who underwent Lp(a) testing, over a median 17.7 years, to assess whether Life's Simple 7 (LS7) lifestyle score modifies ASCVD risk across Lp(a) levels (low below 30, intermediate 30-49, elevated 50 mg/dL or above, present in 20%). Individuals with Lp(a) of 50 mg/dL or above had higher absolute ASCVD event rates across every LS7 category, but there was no significant interaction between Lp(a) and LS7 score on incident ASCVD (P for interaction = 0.60). Compared with a poor LS7 score, an optimal LS7 score conferred lower ASCVD risk regardless of Lp(a) group: HR 0.45 (95% CI 0.28-0.71) for Lp(a) below 30, HR 0.12 (95% CI 0.02-0.89) for 30-49, and HR 0.35 (95% CI 0.13-0.99) for 50 mg/dL or above. The authors conclude a healthy lifestyle reduces ASCVD risk regardless of Lp(a) level, reinforcing the value of risk factor control even in people with elevated Lp(a).

Original abstract

Aims: To assess the association of traditional risk factor burden and Life's Simple 7 (LS7) score with incident atherosclerotic cardiovascular disease (ASCVD) across lipoprotein(a) [Lp(a)] levels.

Methods And Results: There were 6676 participants without clinical ASCVD from the Multi-Ethnic Study of Atherosclerosis who underwent Lp(a) testing and were followed for incident ASCVD events (coronary heart disease and stroke). Low, intermediate, and elevated Lp(a) were defined as <30, 30-49, and ≥50 mg/dL, respectively. Cox proportional hazards regression assessed the association of traditional risk factors and LS7 score (poor: 0-8, average: 9-10, and optimal: 11-14) with incident ASCVD across Lp(a) groups during a median follow-up of 17.7 years, adjusting for demographics and time-varying statin and aspirin therapy. The mean age was 62.1 years, 53% were women, and 61% were non-white. The median Lp(a) was 17 (interquartile range 8-41) mg/dL, 13% had Lp(a) 30-49 mg/dL, and 20% had Lp(a) ≥ 50 mg/dL. Individuals with Lp(a) ≥ 50 mg/dL had higher absolute event rates across all LS7 categories. There was no significant interaction between Lp(a) and LS7 score on incident ASCVD (P-interaction = 0.60). Compared to a poor LS7 score, optimal LS7 conferred a lower risk for incident ASCVD among individuals with Lp(a) < 30 [hazard ratio (HR) = 0.45, 95% confidence interval (CI): 0.28-0.71], Lp(a) 30-49 (HR = 0.12, 95% CI: 0.02-0.89), and Lp(a) ≥ 50 mg/dL (HR = 0.35, 95% CI: 0.13-0.99).

Conclusion: Participants without clinical ASCVD who achieved an optimal LS7 score had ASCVD risk reduction regardless of Lp(a) level. These results emphasize the importance of a healthy lifestyle and ASCVD risk factor control among individuals with elevated Lp(a).

Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.