Lipoprotein(a) Levels Could Help Predict Early Artery Disease Risk

Credit: Unsplash / Robina Weermeijer

Elevated lipoprotein(a) (Lp[a]) levels may serve as a highly valuable tool to assess the likelihood of premature atherosclerotic cardiovascular disease (ASCVD) in at-risk patients, according to a new analysis of 100,000-plus patients.

In fact, the study authors believe that elevated Lp(a) is linked to a doubled risk of composite ASCVD outcomes, as well as coronary or peripheral artery disease, in individuals.

“The findings of the meta-analysis could be clinically relevant,” investigators wrote. “The patients with higher Lp(a) might suffer from ASCVD earlier, so the Lp(a) testing for reclassification in people who are borderline between moderate and high risk and the preventive measures to lower Lp(a) should be taken in time, especially in males, females, Caucasians, South Asians, (familial hypercholesterolemia) patients, and [type 2 diabetes mellitus] patients.”

Many cardiologist specialists and clinicians have expressed interest in exploring the capability and benefit of Lp(a)-lowering therapies at a time of robust cardiovascular drug development. That said, understanding the prognostic value of Lp(a) levels in at-risk patients has remained a hurdle for researchers.

This current research was launched by Tong Liu, MD, PhD, director of the Department of Cardiology at the Second Hospital of Tianjin Medical University, and colleagues to better inform the prognostic value and effects of elevated Lp(a) among younger populations, which they suggest has been the focus of less research in this arena than their older counterparts.

With this in mind, investigators designed their research endeavor as a systematic review and meta-analysis of data within the PubMed and Embase databases from inception through November 12, 2023. The primary outcome of interest for the study was the occurrence of any ASCVD at younger than 65 years of age, with ASCVD defined as coronary artery disease, peripheral artery disease, or stroke.

More than 4,900 articles were returned through the investigators' initial search. Of these, 51 studies with a total patient population of 100,540 individuals were included in the systematic review and meta-analysis.

The mean age of these cohorts ranged from 35.3 to 62.3 years old; the proportion of male participants ranged from 0 to 100%, and the mean follow-up ranged from 1 to 40 years. Investigators pointed out the definition of elevated Lp(a) varied among studies included, with observed definitions of more than 30 mg/dL, more than 50 mg/dL, top turtles, top quartiles, top quintiles, and so on.

A group of three studies reported the association and composite ASCVD. Analysis of these studies indicated elevated Lp(a) level was associated with significant higher risks of composite ASCVD events among individuals at an early age. Further analysis pooling 49 studies focused on individual ASCVD events demonstrated an association between elevated Lp(a) level and overall ASCVD as both a categorical and continuous variable as per 1 SD increase of the log Lp(a), but not for other forms of continuous variable.

Analysis of data from three trials assessing the prognostic value of Lp(a) in patients with familial hypercholesterolemia suggests elevated Lp(a) was associated with premature ASCVD. Analysis of data from two trials provided evidence of a significant association between elevated Lp(a) and premature ASCVD events in patients with type 2 diabetes mellitus.

Additional analysis of individual components of ASCVD suggested there was a positive association between elevated Lp(a) levels with risk of premature coronary artery disease and peripheral artery disease, but not for stroke.

“Our meta-analysis supports that elevated Lp(a) concentration, which is genetically determined, can predict both composite and individual ASCVD in young patients,” investigators concluded. “The presence of high Lp(a) concentration indicates prospective evaluation and validation as a clinical risk factor in premature ASCVD in Caucasians, South Asians, FH population, and patients with the baseline LDL-c level ≥ 100 mg/dL.”

An original version of this article was published on sister site HCPLive.