Elevated Lp(a) associated with CAD in individuals without a family history of CVD
Lipoprotein(a) and Coronary Artery Disease Risk Without a Family History of Heart Disease
Literature - Finneran P, Pampana A, Khetarpal SA et al., - J Am Heart Assoc. 2021 Feb;10(5):e017470. doi: 10.1161/JAHA.120.017470.Introduction and methods
Elevated lipoprotein(a) (Lp[a]) is associated with increased risk for coronary artery disease (CAD) [1]. Lp(a) is a heritable risk factor and a family history of premature atherosclerotic CVD (ASCVD) is listed as an indication for Lp(a) assessment for primary prevention in American cholesterol guidelines [2]. However, the risk of incident CAD in individuals with elevated Lp(a) without a family history of CVD is unknown. This study investigated the incident risk of CAD in participants from the UK Biobank with and without a family history of CVD.
The UK Biobank is a prospective, observational cohort of ~500 000 individuals aged 40 to 69 years. This study analyzed data from 153 228 participants without CAD and with measured Lp(a) at baseline and with a follow-up time of <9 years. Mean age was 58.4 years (SD: 7.9 years), 52.2% were female and the median follow-up was 8.2 years (IQR 7.8-8.6 years). The primary outcome was incident CAD. Risk of incident CAD conferred by Lp(a) was estimated and adjusted for age, sex, self-reported ethnicity, T2DM, smoking status, LDL-c, and statin or ezetimibe use. Incident CAD risk in those without a family history of CVD in a sibling or parent was compared with those with a family history of CVD. The secondary outcome was risk of incident ASCVD, defined as CAD, peripheral arterial disease, or ischemic stroke.
Main results
- HR for incident CAD per 50 nmol/L Lp(a) was 1.18 (95%CI 1.11-1.26, P<0.001) in participants with a family history of CVD and 1.15 (95%CI 1.13-1.17, P<0.001) in those without a family history of CVD (P for interaction=0.73).
- HR for incident CAD associated with Lp(a) >150 nmol/L, compared with Lp(a) <150 nmol/L, was 2.00 (95%CI 1.46-2.74, P<0.001) in those with a family history and 1.68 (95%CI 1.55-1.82, P<0.001) in those without a family history (P for interaction=0.68).
- HR for incident ACSVD per 50 nmol/L Lp(a) was 1.15 (95%CI 1.09-1.21, P<0.001) in those with a family history and 1.12 (95%CI 1.10-1.14, P<0.001) in those without a family history (P for interaction=0.66).
Conclusion
Elevated Lp(a) is associated with an increased risk for incident CAD in individuals without a family history of CVD. The authors state that 'Lp(a) measurement may be beneficial in refining CAD risk in primary prevention patients without a family history of heart disease'.
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