Epidemiology
Higher Lp(a) predicts secondary events after first-time ACS, with levels highest in Indian and lowest in Māori patients, New Zealand's multi-ethnic MENZACS study finds (Atherosclerosis 2025)
Original title: Lipoprotein(a) concentrations and secondary outcomes following first-time acute coronary syndrome: The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS)
The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS) enrolled 1,900 patients during their first acute coronary syndrome admission (mean age 61, 20% female, 73% European, 14% Maori, 5% Pacific peoples, 4% Indian, 3% other), measuring isoform-insensitive Lp(a) to assess secondary-event risk and ethnic variation, an understudied dimension. Among 1,890 patients alive at discharge, 493 (26%) had all-cause mortality or cardiovascular readmission over a median 4.9-year follow-up. Compared with the lowest Lp(a) quartile (7 nmol/L or below), the highest quartile (above 92 nmol/L) carried an adjusted hazard ratio of 1.46 (95% CI 1.12-1.89, P = 0.004) for the primary outcome. Lp(a) concentrations varied markedly by ethnicity, highest in Indian participants (median 27 nmol/L) and lowest in Maori participants (median 12 nmol/L). This multi-ethnic secondary-prevention cohort both confirms Lp(a)'s prognostic value after first ACS and documents ethnic-specific baseline differences relevant to future risk thresholds.
Original abstract
Background And Aims: Lipoprotein(a) (Lp[a]) is an established predictor of cardiovascular risk but associations with secondary events are less certain, and data on understudied ethnic groups are scarce. This study aimed to assess the association between Lp(a) and secondary events and explore variation in Lp(a) levels by ethnicity in first-time acute coronary syndrome (ACS) patients, to inform future risk prediction models.
Methods: The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS) is a longitudinal multi-centre cohort study of 1900 patients enrolled during their ACS admission. Baseline plasma Lp(a) concentrations were measured using an isoform-insensitive assay measured in nmol/L. The primary outcome was a composite of all-cause mortality or cardiovascular readmission, ascertained through national health datasets. Cox regression models were used to assess the association between Lp(a) levels and outcomes, adjusted for clinical risk factors.
Results: The mean age was 61 years, 20 % were female, and 73 % were European, 14 % Māori, 5 % Pacific peoples, 4 % Indian and 3 % other ethnicities. Of 1890 alive at discharge, 493 (26 %) experienced the primary outcome over a median follow-up of 4.9 years. Higher Lp(a) levels were associated with increased risk of secondary events. Compared to the lowest quartile (≤7 nmol/L), the adjusted hazard ratio for the highest quartile (>92 nmol/L) was 1.46 (95 %CI 1.12-1.89, p = 0.004). In this ACS cohort, Lp(a) concentrations varied by ethnicity, being highest amongst Indian participants (median 27 nmol/L) and lowest amongst Māori participants (median 12 nmol/L).
Conclusions: Elevated Lp(a) concentrations are associated with secondary events following ACS. Further research is needed to define optimal thresholds for increased risk and explore ethnic-specific implications for secondary prevention.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.