At the Kahn Center for Cardiac Longevity, we have been checking levels of Lipoprotein(a) or Lp(a) for over a decade in all patients and managing it in hundreds of patients from around the world. We are often successful in lowering it by 50% or more.
It is known that higher levels of Lp(a) drive increasing risk of atherosclerotic cardiovascular disease (ASCVD) in otherwise healthy individuals regardless of sex and race/ethnicity.
It is less clear if elevated levels of Lp(a) also raises risk of future heart events in patients with known ASCVD. It is still unresolved if available pharmaceutical agents might reduced the risk of recurrent events in patients with an elevated Lp(a) and ASCVD.
A new and large study attempted to address these questions.
In US medical claims between 2012 and 2022 for 340 million individuals, 273,770 had diagnosed ASCVD and Lp(a) measured in nmol/L.
Lp(a) levels were higher in women vs men and in Black vs Hispanic and White individuals.
During a median follow-up of 5.4 years, 41 687 individuals (15%) experienced recurrent ASCVD.
Higher Lp(a) levels were associated with continuously increasing risk of recurrent ASCVD. Compared to individuals with lipoprotein(a) < 15 nmol/L, the adjusted hazard ratios for recurrent ASCVD events were 1.04 for 15–79 nmol/L, 1.15 for 80–179 nmol/L, 1.29 (1.25–1.33) for 180–299 nmol/L, and 1.45 (1.39–1.51) for ≥300 nmol/L.
Results were similar for individual ASCVD components, and in sex, race/ethnicity, baseline ASCVD, and diabetes subgroups.
High impact LDL cholesterol-lowering therapy possibly mitigates the deleterious effect of Lp(a) ≥ 180 nmol/L, most pronounced in those on PCSK9 inhibitors.
In 273 770 individuals with ASCVD, higher Lp(a) levels were associated with continuously increasing risk of recurrent ASCVD events regardless of sex and race/ethnicity that may have been partially mitigated by high impact LDL cholesterol-lowering therapy, particularly PCSK9 inhibitor drugs.
An officer of the Family Heart Foundation commented: "While previous smaller studies have shown that the risk of cardiovascular events can increase within certain ranges of Lp(a), this is the first study to show that the risks of cardiovascular events including heart attack, stroke, and cardiac surgeries continue to increase across all ascending levels of Lp(a) and that there is no indication that the risk plateaus. The US has lagged behind many other countries in recommending that adults complete a simple blood test to measure Lp(a). This study strongly confirms the importance of considering Lp(a) levels among other risk factors when determining an individual's risk of future heart attacks and strokes."
At the Kahn Center, we will continue to be focused on measuring and working to lower levels of Lp(a) while we await the results of ongoing clinical trials of new pharmaceutcial approaches. As always, a heart healthy diet (plant based), fitness, sleep optimization, smoking cessation, and stress management will be emphasized.
