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Arnold, N.* ; Goßling, A.* ; Bay, B.* ; Weimann, J.* ; Blaum, C.* ; Brunner, F.J.* ; Ferrario, M.M.* ; Brambilla, P.* ; Cesana, G.* ; Leoni, V.* ; Palmieri, L.* ; Donfrancesco, C.* ; Padró, T.* ; Andersson, J.* ; Jousilahti, P.* ; Ojeda, F.* ; Zeller, T.* ; Linneberg, A.* ; Söderberg, S.* ; Iacoviello, L.* ; Gianfagna, F.* ; Sans, S.* ; Veronesi, G.* ; Thorand, B. ; Peters, A. ; Tunstall-Pedoe, H.* ; Kee, F.* ; Salomaa, V.* ; Schnabel, R.B.* ; Kuulasmaa, K.* ; Blankenberg, S.* ; Waldeyer, C.* ; Koenig, W.*

Lipoprotein (a) and incident coronary heart disease in the community: Impact of traditional cardiovascular risk factors.

Eur. J. Prev. Cardiol., DOI: 10.1093/eurjpc/zwaf340 (2025)
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AIMS: Deleterious effects Lipoprotein (a) (Lp(a)) might be mitigated by overall cardiovascular (CV) risk reduction. However, data on the relationship between increased Lp(a) and incident coronary heart disease (CHD) according to the distribution of modifiable CV risk factors (CVRF) at baseline are still scarce. We investigated the association between high Lp(a) and incident CHD in the general population, depending on the presence/absence of four major CVRFs (hypertension, diabetes, hypercholesterolemia, smoking) at baseline. METHODS: Overall 66,495 CHD-free individuals from eight European prospective population-based cohorts were included. The cohort was stratified according to CVRF burden at baseline in "0/1 CVRF" (low risk; n= 41,770) and"≥2 CVRFs" (increased risk; n=24,725). Fine and Gray competing risk-adjusted models were calculated for the association between Lp(a) mass (<90th versus ≥90th percentile (pctl.); cut-off 43.2 mg/dL) and future CHD events. RESULTS: During a median follow-up of 9.7 years, 3,467 incident CHD events occurred. Despite being at very low absolute risk based on traditional CVRF, individuals with 0/1CVRF demonstrated a strong association between increased Lp(a) mass (≥90th pctl.) and future CHD events, which was comparable to the association observed among individuals with ≥2 CVRFs. The fully-adjusted sub-distribution Hazard Ratios [sHRs] for elevated Lp(a) were 1.38 (95% CI, 1.12-1.71) versus 1.27 (95% CI, 1.10-1.46) in those having 0/1 versus ≥2 CVRFs at baseline (Pinteraction0.50). CONCLUSION: Among CHD-free subjects, high Lp(a) was related to adverse outcome even in individuals with no or only one CVRF at baseline, thereby generating substantial challenges in mitigating Lp(a)-associated CHD risk in very low risk populations.
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Publication type Article: Journal article
Document type Scientific Article
Keywords Lipoprotein (a) ; General Population ; Incident Coronary Heart Disease ; Primary Prevention ; Traditional Modifiable Risk Factors
Language english
Publication Year 2025
HGF-reported in Year 2025
ISSN (print) / ISBN 2047-4873
e-ISSN 2047-4881
Journal European Journal of Preventive Cardiology
Publisher Sage
Publishing Place Great Clarendon St, Oxford Ox2 6dp, England
Reviewing status Peer reviewed
Institute(s) Institute of Epidemiology (EPI)
POF-Topic(s) 30202 - Environmental Health
Research field(s) Genetics and Epidemiology
PSP Element(s) G-504000-002
G-504000-010
Grants European research consortium
European Union Seventh Framework Programme Collaborative Project
DOI 10.1093/eurjpc/zwaf340
WOS ID 001523260200001
PubMed ID 40504886
Erfassungsdatum 2025-06-30
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