Lipoprotein(a), Family History Make Additive Contributions to Cardiovascular Risk

By David Douglas

August 13, 2020

NEW YORK (Reuters Health) - Family history and plasma lipoprotein(a) (Lpa) levels contribute independently to cardiovascular-disease risk and both should be taken into consideration to enhance prevention strategies, researchers say.

"Lipoprotein(a) is increasingly being measured in clinical practice to assess cardiovascular risk, frequently in patients with a strong family history of heart attacks," Dr. Amit Khera of the University of Texas Southwestern Medical Center, in Dallas, told Reuters Health by email

"We found that having both an elevated Lpa and a family history of heart attack are additive, such that individuals with both of these characteristics are worse off than those with either alone," he said.

In a paper in the Journal of the American College of Cardiology, Dr. Khera and colleagues note that circulating levels of Lpa are determined primarily by heredity. A number of studies have established Lpa as an independent and likely causal risk factor for atherosclerotic cardiovascular disease (ASCVD). This is also the case for a family history of such disease, but, say the researchers, "their independent and joint associations with long-term risk are unclear."

To investigate, the team studied data on more than 12,000 asymptomatic participants in a population-based study. Over 21 years of follow-up, there were 3,114 ASCVD events. A family history of coronary heart disease was independently associated with ASCVD (hazard ratio, 1.17) as were elevated levels of Lpa (HR, 1.25).

There was no significant interaction between Lpa and family history (P=0.75)

Participants positive for either of these factors were at higher risk than those with neither, but the highest risk was seen in those with both (HR, 1.43). There were similar findings in different analyses and in an independent cohort with more than 2,700 participants.

In an accompanying editorial, Dr. Paul N. Durrington of the University of Manchester, U.K., observed that previous studies including both as covariates "have been too small to be sure whether they acted in concert or simply overlapped in their association with ASCVD."

He told Reuters Health by email, "Clinicians treating lipid disorders should always include family history in making decisions about atherosclerotic cardiovascular disease risk and treatment. Lipoprotein(a) also contributes independently to risk and (testing) should be more widely available."

SOURCE: https://bit.ly/3kuPkbf and https://bit.ly/30KKyhV Journal of the American College of Cardiology, online August 10, 2020.

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