Physician-authored summaries and commentary on the most important medical research, provided by the NEJM Group, a division of the Massachusetts Medical Society.
© Massachusetts Medical SocietySeptember 2024
Observational data show an association, regardless of the presence or number of other modifiable cardiovascular risk factors.
Lipoprotein(a) (Lp[a]) is associated with coronary artery disease and myocardial infarction (MI) in genetic and epidemiological studies; however, Lp(a) risk within the context of modifiable cardiovascular risk factors is not well studied.
In the current retrospective analysis, investigators assessed risk for acute first MI among 6238 adults with an Lp(a) measurement taken during routine care and no known atherosclerotic cardiovascular disease. Standard modifiable risk factors for first MI were diabetes, dyslipidaemia, hypertension and smoking. High Lp(a) was defined as a value above the 90th percentile and low Lp(a) below the 50th percentile in the cohort.
During a median follow up of nine years, 4% of patients experienced an incident MI. First MI incidence was significantly and meaningfully higher with high versus low Lp(a) regardless of the number of other risk factors. After adjusting for age, sex and number of risk factors, having high Lp(a) was significantly associated with a nearly threefold higher risk for first MI. The risk associated with elevated Lp(a) was similar to having two additional risk factors.
Comment: Recognising the potential limitations of this observational study, its results provide further evidence for a strong association between Lp(a) and cardiovascular risk. Despite the lack of current effective therapies to reduce Lp(a), these findings support the use of Lp(a) to improve risk assessment in primary and secondarycare patient populations. Based on the totality of the evidence, I plan to discuss Lp(a) testing with all of my cardiology patients and will recommend it for primary care patients with any known cardiovascular risk factors in our safety net institution.
Shea E. Hogan, MD, MSCS, FACC, FSCAI, FSVM, Interventional Cardiologist, Denver Health; Associate Professor of Clinical Medicine, University of Colorado School of Medicine; Clinician-Scientist, CPC Clinical Research, Denver, USA.
Shiyovich A, et al. Association of lipoprotein (a) and standard modifiable cardiovascular risk factors with incident myocardial infarction: the Mass General Brigham Lp(a) Registry. J Am Heart Assoc 2024; 13: e034493.
This summary is taken from the following Journal Watch title: Cardiology.