Epidemiology
Elevated Lp(a) improves 20-year ASCVD risk reclassification beyond HellenicSCOREII+, two Greek cohorts (J Clin Lipidol 2026)
Original title: Country-specific prevalence and clinical relevance of elevated Lp(a) as a risk enhancer in 2 Greek cohorts
Analysis of two Greek cohorts: a tertiary lipid clinic cohort (Athens Angiometabolic Cohort, AAC, n=1106) and a general-population cohort with 20-year follow-up (ATTICA study, n=2682), evaluating Lp(a) as a cardiovascular risk enhancer. Elevated Lp(a) was found in 8.3% of the general population (50 mg/dL or more) and 18.9% of the lipid clinic cohort (125 nmol/L or more; 16.0% without and 22.1% with ASCVD, p=0.006), and was associated with greater carotid, coronary and lower-extremity atherosclerosis (p<0.05 for all). Both European Atherosclerosis Society (EAS) recommendations (net reclassification index 0.170) and a sex-specific inflation factor (NRI 0.176) improved 20-year ASCVD risk reclassification over HellenicSCOREII+ alone; only the EAS approach gave significant reclassification for 10-year cardiovascular death. Lp(a) also increased eligibility for more aggressive primary prevention (23.6% AAC/13.6% AS by EAS; 25.6% AAC/22.3% AS by inflation factor). The authors conclude Lp(a) meaningfully improves ASCVD risk reclassification beyond the validated Greek risk score.
Original abstract
Background: National epidemiologic data are needed to inform country-specific healthcare policies for prevention and new developing treatments.
Objective: We aimed to analyze Greek epidemiologic data in clinically relevant special populations for targeted treatments and to evaluate the utility of lipoprotein(a) [Lp(a)] as a risk enhancer METHODS: Two independent cohorts were included in this analysis: (1) consecutively recruited patients assessed in a tertiary outpatients' lipid clinic (Athens Angiometabolic cohort [AAC], n = 1106) with available peripheral vascular markers, and (2) sample of the Greek general population (ATTICA study [AS], n = 2682) with available 20-year follow-up data for atherosclerotic cardiovascular disease (ASCVD) events.
Results: Increased Lp(a) was found in 8.3% of the AS (≥50 mg/dL) and in 18.9% of the AAC (≥125 nmol/L) (16.0% without ASCVD and 22.1% with ASCVD, P = .006). Elevated Lp(a) levels were associated with increased carotid, coronary artery, and lower extremity atherosclerosis (P < .05 for all). Both the European Atherosclerosis Society (EAS) recommendations (net reclassification index [NRI]: 0.170) and a derived sex-specific inflation factor for HellenicSCOREII+ (NRI: 0.176) were efficient in incorporating Lp(a) as a risk enhancer over HellenicSCOREII+ for 20-year major adverse cardiovascular events. For 10-year cardiovascular death, only the EAS consensus provided significant reclassification. Finally, Lp(a) conferred increased eligibility for more aggressive primary prevention measures both by EAS recommendations (23.6% in AAC/13.6% in AS) and by sex-specific inflation factors (25.6% in AAC/22.3% in AS).
Conclusion: Elevated Lp(a) levels were observed in 8.3% of the general population cohort and up to 23.9% in participants with ASCVD from the lipid clinic cohort, highlighting a risk gradient across ASCVD categories. Incorporating Lp(a) as a risk enhancer improves ASCVD risk reclassification beyond the validated HellenicSCOREII+.
ancestryepidemiologyrisk prediction
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.