Prevention & lipidsCohort study
Combined Low-density Lipoprotein Cholesterol (LDL-C), Lp(a), and High-sensitivity C-reactive Protein (hsCRP) Assessment Predicts Atherosclerotic Cardiovascular Disease (ASCVD) in the Multiethnic HELIUS Cohort
- Prospective cohort study
- multiethnic
- competing-risk analysis
Authors' conclusion
In a multiethnic primary prevention cohort, combined assessment of LDL-C, Lp(a), and hsCRP identified individuals at elevated long-term risk through independent pathways, with consistent relative risk gradients but divergent absolute risks across ethnicities.
Study context
- Population
- Participants of African, European and South Asian Surinamese descent without prior MI or ischemic stroke (HELIUS)378 ASCVD events
- Participants
- 15,676 participants
- Exposure
- Top vs bottom quintile of LDL-C, Lp(a) and hsCRP; number of elevated biomarkers
- Outcome
- Incident ASCVD
- Follow-up
- median 8.9-year follow-up
Main finding
As reported in the abstract
Incident ASCVD, top vs bottom quintile · median 8.9 years
Adjusted subdistribution hazard ratio (95% CI)
LDL-C top quintile vs LDL-C bottom quintile
1.39(1.09–1.79)
Lp(a) top quintile vs Lp(a) bottom quintile
1.86(1.54–2.25)
hsCRP top quintile vs hsCRP bottom quintile
1.51(1.34–1.71)
Fold increase (95% CI)
All 3 biomarkers elevatedrisk increased with number of elevated biomarkers
2.44(1.46–4.09)
Observational data: associations, not effects.
Further findings
Consistency across ethnic groups
- Consistent dose-response patterns across ethnic groups
- P for interaction = 0.75
- Absolute ASCVD risk approximately 3-fold higher in South Asian Surinamese participants
Adding Lp(a) and hsCRP to a PREVENT-ASCVD-based clinical model · 10 years
- Δ AUC
- 0.006; P = 0.030
- Continuous net reclassification improvement
- 0.165; 95% CI: 0.050-0.289
Original publication
Combined LDL-C, Lp(a), and hsCRP Assessment Predicts ASCVD in the Multiethnic HELIUS Cohort. J Am Coll Cardiol. Published 15 June 2026. doi:10.1016/j.jacc.2026.05.006
Summarised from the published abstract; every number is checked against it