Eur Heart J

High Lp(a) levels linked to increased risk for recurrent CV events

May 19, 2025

Study details: This retrospective cohort study followed 273,770 U.S. individuals with atherosclerotic cardiovascular disease (ASCVD) for a median of 5.4 years, tracking CV events such as MI, ischemic stroke, percutaneous coronary intervention, or coronary artery bypass graft. Participants were categorized into five groups based on lipoprotein(a) [Lp(a)] levels: low (<15 nmol/L), moderate (15-79 nmol/L), moderate-to-high (80-179 nmol/L), high (180-299 nmol/L), and very high (≥300 nmol/L). The cohort included diverse demographics: 43% women, 57% men, 8% Black, 9% Hispanic, and 59% White individuals.

Results: Individuals with the highest Lp(a) levels (≥ 300 nmol/L) were about 40% more likely to experience a CV event within five years compared with those with the lowest levels (<15 nmol/L). The risk was consistent across sex, race/ethnicity, baseline ASCVD, and diabetes subgroups. Notably, high-impact LDL cholesterol-lowering therapy, particularly PCSK9 inhibitors, appeared to mitigate the risk associated with Lp(a) levels ≥ 180 nmol/L.

Clinical impact: The findings underscore the importance of Lp(a) as a predictor of recurrent ASCVD events, independent of traditional risk factors. Aggressive LDL cholesterol-lowering strategies, especially with PCSK9 inhibitors, may be beneficial in patients with elevated Lp(a) levels.

Source:

MacDougall DE, et al. (2025, May 7). Eur Heart J. Lipoprotein(a) and recurrent atherosclerotic cardiovascular events: the US Family Heart Database. https://pubmed.ncbi.nlm.nih.gov/40331569/