Lipoprotein(a), LDL on “on steroids”?

Some have called Lipoprotein(a), known in short as Lp(a) as low density lipoprotein particle on steroids, while others have called it the ‘ugly’ cholesterol where as LDL cholesterol is bad cholesterol and HDL cholesterol the good cholesterol. Reason is that extensive data suggest it as a causal factor for atherosclerotic cardiovascular disease [1]. Lp(a) levels above 50 mg/dL which is present in about a fifth of the global adult population is thought to increase risk and need intensification of therapies reducing risk of atherosclerotic cardiovascular disease like statins. Now we have a real-world registry data of patients with Lp(a) levels collected during routine clinical practice [2].

A retrospective cohort of patients with Lp(a) measured at two medical centres from 2000 to 2019 were studied. Association of Lp(a) with major adverse cardiovascular events – nonfatal myocardial infarction, nonfatal stroke, coronary revascularization, or cardiovascular mortality was evaluated. Nearly sixteen and a half thousand people were analysed and had a mean follow up period of 11.9 years. Nearly ten thousand had baseline atherosclerotic cardiovascular disease. Among these persons, those in the 71st to 90th percentile of Lp(a) levels (112-215 nmol/L) had 21% increased hazard of major adverse cardiovascular events. This was similar to those in the 91st to 100th percentile group. The risk was particularly for myocardial infarction and coronary revascularization.

A little over six thousand two hundred did not have atherosclerotic cardiovascular disease at baseline. Among them, there was a continuously higher hazard of MACE with increasing Lp(a) levels. Those in the 91st to 100th Lp(a) percentile group had the highest relative risk of 1.93.

References

1. Wong ND. Lipoprotein(a): Ready for Prime Time? J Am Coll Cardiol. 2024 Mar 5;83(9):887-889. doi: 10.1016/j.jacc.2024.01.004. PMID: 38418001.
2. Berman AN, Biery DW, Besser SA, Singh A, Shiyovich A, Weber BN, Huck DM, Divakaran S, Hainer J, Kaur G, Blaha MJ, Cannon CP, Plutzky J, Januzzi JL, Booth JN 3rd, López JAG, Kent ST, Nasir K, Di Carli MF, Bhatt DL, Blankstein R. Lipoprotein(a) and Major Adverse Cardiovascular Events in Patients With or Without Baseline Atherosclerotic Cardiovascular Disease. J Am Coll Cardiol. 2024 Mar 5;83(9):873-886. doi: 10.1016/j.jacc.2023.12.031. PMID: 38418000.