Epidemiology
German men have more than double the Lp(a) of German women, and 1 in 5 adults from a pre-statin-era population exceeded 50 mg/dL, national survey finds (JACC Adv 2025)
Original title: Association of Lipoprotein(a) With Cardiovascular and Cerebrovascular Disease in a Nationally Representative Cohort of Germany
This study filled a gap in population-based German Lp(a) data by analysing 6,657 participants in the German National Health Interview and Examination Survey 1998, a study representative of the German adult population's health status from 1997 to 1999, before statins were in widespread use. Median Lp(a) was 15.3 mg/dL (Q1-Q3 5.6-43.1), with 21.6% at or above 50 mg/dL; men had substantially higher median Lp(a) than women (22.1 vs. 10.3 mg/dL). Median Lp(a) was significantly higher in those with a history of atherosclerotic cardiovascular disease (ASCVD) than without, but did not differ by venous thrombosis history; in logistic regression, Lp(a) of 50 mg/dL or above was independently associated with ASCVD history (OR 1.36, 95% CI 1.04-1.78, P = 0.023). This nationally representative, pre-statin-era baseline establishes the German Lp(a) distribution and its ASCVD-specific, non-thrombotic association, providing a foundation for future prospective German studies.
Original abstract
Background: Population-based data on the distribution of lipoprotein(a) (Lp[a]) within the German population are lacking.
Objectives: The aim of the study was to determine the age- and sex-specific Lp(a) distribution in Germany and analyze its association with different types of cardiovascular disease (CVD).
Methods: We analyzed cross-sectional data from the German National Health Interview and Examination Survey 1998, a population-based study representing the German adult population's health status from 1997 to 1999. We examined serum Lp(a) according to demographics and investigated associations between Lp(a) and history of self-reported CVD. We tested Lp(a) in spline analysis on continuous scales and as dichotomous Lp(a) thresholds.
Results: In the German National Health Interview and Examination Survey 1998 (n = 6,657), median Lp(a) was 15.3 mg/dL (Q1-Q3: 5.6, 43.1). Lp(a) levels ≥50 mg/dL were present in 21.6%. Men had substantially higher median Lp(a) than women (22.1 mg/dL vs 10.3 mg/dL). Median Lp(a) levels were significantly higher in individuals with than without a history of atherosclerotic cardiovascular disease (ASCVD) but did not significantly differ between people with and without venous thrombosis. In logistic regression analysis with splines, higher Lp(a) levels were associated with a higher probability of a history of CVD. In logistic regression analyses, Lp(a) ≥50 mg/dL was associated with a history of ASCVD (OR: 1.36 [95% CI: 1.04-1.78]; P = 0.023).
Conclusions: About 1 in 5 German individuals from a prestatin era population had Lp(a) levels ≥50 mg/dL. Higher levels were independently associated with ASCVD, but not with venous thrombosis. These findings provide a basis for future prospective studies to define the role of Lp(a) in CVD risk in the German population.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.