Inflammation
In patients 75 and older with established ASCVD, inflammation predicts MACE more strongly than Lp(a), 2,333-patient Fuwai Hospital study finds (Age Ageing 2025)
Original title: Residual atherosclerotic risk in older patients with atherosclerotic cardiovascular disease: where inflammation meets lipoprotein(a)
This prospective study enrolled 2,333 patients aged 75 years or older with established atherosclerotic cardiovascular disease at Fuwai Hospital, measuring hsCRP and Lp(a) to compare their relative importance for major adverse cardiovascular events (MACE) over a median 3.0-year follow-up. hsCRP was significantly associated with higher MACE risk (adjusted HR 1.05 per 1 mg/L increment, 95% CI 1.03-1.08, P < 0.001; highest vs. lowest quartile aHR 1.70), whereas Lp(a) showed no significant association with MACE (aHR 1.02 per 10 mg/dL increment, 95% CI 0.98-1.06, P = 0.341; highest vs. lowest quartile aHR 1.06). MACE risk was significantly higher with hsCRP of 2 mg/L or above regardless of Lp(a) status (aHR 1.41, P = 0.004), and elevated hsCRP plus elevated Lp(a) carried the highest risk (aHR 1.54, P = 0.007). Inflammation outperformed Lp(a) as a risk marker in this older population, suggesting anti-inflammatory strategies may be the more promising secondary-prevention target here.
Original abstract
Background: Inflammation and hyperlipidaemia contribute with similar magnitude to the risk of future atherothrombotic events. However, the relative importance of high-sensitivity CRP (hsCRP) and lipoprotein(a) (Lp[a]) as determinants of risk of major adverse cardiovascular events (MACE) are not well defined among patients aged 75 years or older with established atherosclerotic cardiovascular disease (ASCVD).
Methods: The present study prospectively enrolled 2,333 patients aged 75 years or older diagnosed with ASCVD with measurement of hsCRP and Lp(a) at Fuwai Hospital. The primary endpoint was MACE, defined as a composite of all-cause death, myocardial infarction (MI), stroke or ischaemia-driven coronary revascularisation.
Results: The median follow-up time was 3.0 years (interquartile range [IQR]: 2.5-3.2 years). hsCRP was significantly associated with an increased risk of MACE (adjusted hazard ratio [aHR]: 1.05, 95% confidence interval [CI]: 1.03-1.08 per 1 mg/l increment, P < 0.001; highest versus lowest quartile: aHR: 1.70 [1.22-2.38]), whereas there was no significant association between Lp(a) and MACE risk (aHR: 1.02 [0.98-1.06] per 10 mg/dl increment, P = 0.341; highest versus lowest quartile: aHR: 1.06 [0.77-1.47]). Risks of MACE were significantly higher in participants with hsCRP ≥2 mg/l than in those with hsCRP <2 mg/l, irrespective of Lp(a) strata (aHR: 1.41 [1.12-1.79]; P = 0.004). Concomitant elevation of hsCRP (≥2 mg/l) and Lp(a) (≥30 mg/dl) was associated with the greatest risk of MACE (aHR, 1.54 [1.13-2.12]; P = 0.007).
Conclusions: Inflammation assessed by hsCRP predicted risk of future cardiovascular events more strongly than Lp(a) in patients aged 75 years or older with established ASCVD. These results provided real-world evidence on older patients potentially benefit by targeted anti-inflammatory strategies for secondary ASCVD prevention.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.