STUDY BACKGROUND
At the KAHN CENTER, every patients is tested for the blood level of Lipoprotein(a), a genetic cholesterol that is common and has the potential to cause atherosclerosis and aortic valve calcification. All patients are also encouraged to get a coronary artery calcium (CAC) score unless they already have known heart disease (heart attack, bypass surgery, stent, prior cath). More data is needed on the implications of these two tests.
The utility of CAC scoring in individuals with elevated lipoprotein(a) [Lp(a)] for atherosclerotic cardiovascular disease (ASCVD) risk assessment is currently unclear given the propensity of Lp(a) toward noncalcified plaque. A
new study provides important information to consider.
STUDY
The authors aimed to evaluate the interaction between elevated Lp(a) (>50 mg/dL) and CAC score, and the association of Lp(a) with ASCVD risk across strata of CAC.
A pooled cohort of participants without known ASCVD from 4 U.S.-based prospective cohort studies with baseline Lp(a) and CAC measurements was used. The association between elevated Lp(a) across CAC strata and incident ASCVD (myocardial infarction, stroke, coronary revascularization) was evaluated in multivariable Cox regression models.
RESULTS
The study included 11,319 participants (mean age 56 years, 54% women) with 1,569 incident ASCVD events over 15 year mean follow-up.
Lp(a) >50 mg/dL or about 125 nmol/L (HR: 1.24; 95% CI: 1.09-1.41) and CAC >0 (HR: 2.44; 95% CI: 2.14-2.77) were independently associated with ASCVD risk.
Among individuals with CAC = 0, ASCVD incidence rates were low overall, but higher with Lp(a) >50 mg/dL vs ≤50 mg/dL (4.9 vs 3.8/1,000 person-years).
Among those with CAC >0, increased risk was again noted with elevated Lp(a) (21.2 vs 18.2/1,000 person-years, HR: 3.03).
Similar results were observed when examining further CAC strata with the greatest risk noted with both CAC ≥300 and Lp(a) >50 mg/dL (HR: 6.12).
Consistent results were noted by age and sex with greater absolute risk in general among individuals >50 years of age and men.
CONCLUSIONS
Elevated Lp(a) is associated with higher relative risk across CAC strata, including CAC of 0 but the risk with a CAC score of ZERO is still very low and all patients >age 40 with an elevated Lp(a) level should consider a CAC test.
Among individuals with CAC of 0, absolute event rates remain low even when Lp(a) is elevated. CAC scoring remains a powerful tool for risk assessment among individuals with elevated Lp(a).
