Epidemiology
High Lp(a) and high BMI jointly maximize ASCVD risk, Danish and UK Biobank cohorts of 512,687 (Eur J Prev Cardiol 2026)
Original title: High lipoprotein(a) and high BMI jointly confer the highest risk of ASCVD in both primary and secondary prevention
Prospective cohort study combining the Copenhagen General Population Study (CGPS) and UK Biobank, 512,687 individuals without and 14,161 with established ASCVD (39,255 and 3,501 incident ASCVD events respectively), testing whether high Lp(a) and high BMI jointly confer greater ASCVD risk than either alone. In primary prevention, hazard ratios for high Lp(a) (95th-100th percentile) plus BMI above 30 were 1.97 (95% CI 1.61-2.40, CGPS) and 2.19 (95% CI 2.01-2.37, UK Biobank) versus low Lp(a) and normal BMI. Absolute 10-year risk at ages 70-79 was higher for high Lp(a) with moderate BMI (27-30) than for low Lp(a) with obesity (BMI above 30): 25% versus 17% in women and 41% versus 28% in men. Results were similar in secondary prevention. The authors conclude high Lp(a) and high BMI jointly confer the highest ASCVD risk, arguing for Lp(a) measurement in overweight treatment decisions currently based on BMI alone.
Original abstract
Aims: Novel pharmaceuticals lower body mass index (BMI) and reduce risk of atherosclerotic cardiovascular disease (ASCVD), yet treatment indications for BMI 27-30 kg/m² require additional risk factors. High lipoprotein(a), present in 1 in 5 individuals, is a risk factor for ASCVD not included in overweight treatment guidelines. We hypothesised that high lipoprotein(a) and BMI jointly confer the highest risk of ASCVD.
Methods: Prospective cohort study of 512,687 women and men without and 14,161 with ASCVD from the Copenhagen General Population Study (CGPS) and the UK Biobank. During follow-up, 39,255 and 3,501 developed ASCVD in primary and secondary prevention.
Results: In primary prevention, hazard ratios for ASCVD for individuals with high lipoprotein(a) (95th-100th percentile) and BMI>30 were 1.97 (95% CI:1.61-2.40) in the CGPS and 2.19 (2.01-2.37) in the UK Biobank when compared to low lipoprotein(a) (1st-49th percentile) and BMI of 18.5-26.9 kg/m². Absolute risks were higher for concomitant high lipoprotein(a) and BMI 27-30 kg/m² than for BMI>30 kg/m² and low lipoprotein(a), with 10-year absolute risks for ages 70-79 of 25% in women and 41% in men for lipoprotein(a) 95th-100th percentiles and BMI 27-30 kg/m², and correspondingly 17% and 28% for lipoprotein(a) 1st-49th percentiles and BMI>30 kg/m². In secondary prevention, overall results were similar, with higher risks for individuals with high lipoprotein(a) and BMI 18.5-26.9 kg/m², than for BMI≥27 kg/m2 and low lipoprotein(a).
Conclusion: High lipoprotein(a) and high BMI jointly confer the highest risk of ASCVD in primary and secondary prevention.
epidemiologyriskrisk prediction
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.