Lipoprotein(a) levels in a global population with established atherosclerotic cardiovascular disease
Ulf Landmesser,
Børge G Nordestgaard,
Leslie Cho,
Niels Eske Bruun,
Sotirios Tsimikas,
Stephen J Nicholls,
A Michael Lincoff,
Steven E Nissen,
Eran Leitersdorf,
Kathy Wolski,
John Kastelein,
Michael Blaha,
Ryuichi Morishita,
Junhao Liu,
Brian Manning,
Plamen Kozlovski,
Anastasia Lesogor,
Tom Thuren,
Taro Shibasaki,
Florin Matei,
Fábio Serra Silveira,
Andreas Meunch,
Aysha Bada,
Vinod Vijan
Affiliations
Ulf Landmesser
3 Department of Cardiology, Campus Benjamin Franklin (CBF), Charité - Universitätsmedizin Berlin, Berlin, Germany
Børge G Nordestgaard
1 Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
Leslie Cho
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Niels Eske Bruun
Department of Cardiology, Zealand University Hospital, University of Copenhagen, Copenhagen, Denmark
Sotirios Tsimikas
10 Department of cardiology, University of California San Diego, La Jolla, California, USA
Stephen J Nicholls
Monash Cardiovascular Research Centre, Victorian Heart Institute, Monash University, Melbourne, Victoria, Australia
A Michael Lincoff
Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Steven E Nissen
Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
Eran Leitersdorf
12Department of Medicine, Center for Research, Prevention and Treatment of Atherosclerosis, Hadassah Hebrew University Medical Centre, Jerusalem, Israel
Kathy Wolski
Cleveland Clinic Cardiovascular Coordinating Center, Cleveland, Ohio, USA
John Kastelein
Academic Medical Center, Amsterdam, The Netherlands
Michael Blaha
Johns Hopkins, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland, USA
Ryuichi Morishita
Center of Medical Innovation and Translational Research School of Medicine, Osaka University, Suita, Osaka, Japan
Junhao Liu
Novartis Pharmaceuticals, East Hanover, New Jersey, USA
Brian Manning
Novartis Pharmaceuticals, East Hanover, New Jersey, USA
Plamen Kozlovski
Novartis Pharma AG, Basel, Switzerland
Anastasia Lesogor
Novartis Pharma AG, Basel, Switzerland
Tom Thuren
Novartis Pharmaceuticals, East Hanover, New Jersey, USA
Taro Shibasaki
Saitama Sekishinkai Hospital, Sayama-city, Saitama, Japan
Florin Matei
Clinica Matcord, Buzău, Romania
Fábio Serra Silveira
Research Center Clínica do Coração, Aracaju-SE, Brazil
Andreas Meunch
SEC Clinical Research, Andalusia, Alabama, USA
Aysha Bada
Chris Hani Baragwanath Hospital, Soweto, South Africa
Vinod Vijan
Vijan Cardiac & Critical Care Centre, Maharashtra, India
Objective Lipoprotein(a) (Lp(a)) is an important genetically determined risk factor for atherosclerotic vascular disease (ASCVD). With the development of Lp(a)-lowering therapies, this study sought to characterise patterns of Lp(a) levels in a global ASCVD population and identify racial, ethnic, regional and gender differences.Methods A multicentre cross-sectional epidemiological study to estimate the prevalence of elevated Lp(a) in patients with a history of myocardial infarction, ischaemic stroke or peripheral artery disease conducted at 949 sites in 48 countries in North America, Europe, Asia, South America, South Africa and Australia between April 2019 and July 2021. Low-density lipoprotein cholesterol (LDL-C) and Lp(a) levels were measured either as mass (mg/dL) or molar concentration (nmol/L).Results Of 48 135 enrolled patients, 13.9% had prior measurements of Lp(a). Mean age was 62.6 (SD 10.1) years and 25.9% were female. Median Lp(a) was 18.0 mg/dL (IQR 7.9–57.1) or 42.0 nmol/L (IQR 15.0–155.4). Median LDL-C was 77 mg/dL (IQR 58.4–101.0). Lp(a) in women was higher, 22.8 (IQR 9.0–73.0) mg/dL, than in men, 17.0 (IQR 7.1–52.2) mg/dL, p<0.001. Black patients had Lp(a) levels approximately threefold higher than white, Hispanic or Asian patients. Younger patients also had higher levels. 27.9% of patients had Lp(a) levels >50 mg/dL, 20.7% had levels >70 mg/dL, 12.9% were >90 mg/dL and 26.0% of patients exceeded 150 nmol/L.Conclusions Globally, Lp(a) is measured in a small minority of patients with ASCVD and is highest in black, younger and female patients. More than 25% of patients had levels exceeding the established threshold for increased cardiovascular risk, approximately 50 mg/dL or 125 nmol/L.Trial registration number
