Elevated Lp(a) associated with higher CAC score in individuals with family history of ASCVD
Elevated Lipoprotein(a) levels are associated with coronary artery calcium scores in asymptomatic individuals with a family history of premature atherosclerotic cardiovascular diseaseLiterature - Verweij SL, de Ronde MWJ, Verbeek R et al. - J Clin Lipidol 2018; published online ahead of print
- 24% of individuals with elevated Lp(a) levels had an absolute CAC score ≥100 compared to 15% of individuals with normal Lp(a) levels (OR 1.79, 95%CI:1.13-2.83, after adjustment for CV risk factors OR 2.33, 95%CI:1.36-4.00).
- In the group of elevated Lp(a) levels, 40% had a gender and age-corrected CAC score ≥80th percentile compared to 28% in the normal Lp(a) group (OR 1.69, 95%CI:1.14-2.50, after adjustment for CV risk factors: OR 1.85, 95% CI:1.21-2.82).
- Patients with premature ASCVD had a higher prevalence of CV events (39%) when Lp(a) was elevated compared to patients with normal Lp(a) levels (30%) (OR 1.49, 95%CI: 1.11-2.01, after adjustment for CV risk factors: OR 1.78, 95%CI: 1.25-2.54).
- In patients with premature ASCVD, elevated Lp(a) was associated with multivessel disease (≥2 affected coronaries with substantial plaques) (OR 1.88, 95%CI: 1.08-3.28), also after adjustment for CV risk factors (OR: 1.89, 95%CI:1.04-3.45).
In asymptomatic individuals with a family history of ASCVD, elevated Lp(a) levels were associated with higher CAC score, both absolute and, age and gender-corrected CAC score percentiles, independent of CV risk factors. These data support the current EAS recommendation to measure Lp(a) in individuals with family history of premature ASCVD to identify subclinical atherosclerosis in healthy family members. For primary prevention, statin therapy could be started in these individuals with elevated Lp(a).