What is the role of Lp(a) in determining cardiovascular disease risk?

Updated: Aug 05, 2019
  • Author: Abimbola Farinde, PharmD, PhD; Chief Editor: Eric B Staros, MD  more...
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In the Copenhagen Heart study, Kamstrup et al found that genetic elevations of Lp(a) were associated with an increased risk of myocardial infarction. [6] Furthermore, several prospective epidemiological studies have indicated a causal role for Lp(a) in cardiovascular disease; thus, measurement of Lp(a) may be used as a determinant of cardiovascular risk within the context of a global cardiovascular risk assessment.

A study by Muramatsu et al indicated that in individuals with coronary artery disease, those carrying high levels of Lp(a) have a greater prevalence of the form of vulnerable plaque known as thin-cap fibroatheroma (TCFA). The investigators found that TCFA occurred in 23% of patients with an Lp(a) level of 25 mg/dL or higher, compared with 11% of patients with an Lp(a) level below 25 mg/dL. [7]

Using data from the Copenhagen General Population Study and the Copenhagen City Heart Study, Langsted et al found evidence that elevated Lp(a) plasma levels can be linked to increased ischemic stroke risk. The investigators reported that persons with Lp(a) levels above 93 mg/dL had a multivariable-adjusted hazard ratio for ischemic stroke of 1.60, when compared with subjects whose Lp(a) levels were below 10 mg/dL. [8]

Lp(a) is not recommended to be used alone as a sole test for determining cardiovascular risk, but rather as an additional measure to be combined with assessment of traditional cardiovascular risk factors. The measurement of Lp(a) may be most useful in intermediate-risk patients or in those in whom the test result would affect treatment or the aggressiveness of treatment of known cardiovascular risk factors.

As noted by Ridker and Libby, it is uncertain whether the assessment of Lp(a) truly adds prognostic information to overall risk in primary prevention; however, in most studies, Lp(a) has predictive value for those already known to be at high risk because of the presence of other risk factors, in particular elevated LDL-C levels. [3]

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