Prevention & lipidsCohort study
Impact of Lipoprotein(a) Level on Low-Density Lipoprotein Cholesterol– or Apolipoprotein B–Related Risk of Coronary Heart Disease
- Prospective cohort study
- competing risk-adjusted (Fine and Gray) models
Authors' conclusion
Correction of LDL-C for its Lp(a)-C content provided no meaningful information on CHD-risk estimation at the population level. Simple categorization of Lp(a) mass (≥/<90th percentile) influenced the association between LDL-C or apoB with future CHD mostly at higher Lp(a) levels.
Study context
- Population
- Coronary heart disease (CHD)-free subjects at baseline, general population
- Participants
- 68,748 subjects
- Exposure
- Low-density lipoprotein cholesterol (LDL-C) vs Lp-corrected LDL-C; LDL-C and apolipoprotein B (apoB) stratified by Lp mass
- Outcome
- Incident CHD
Main finding
As reported in the abstract
Incident CHD, top vs bottom fifth (fully adjusted)
Subdistribution hazard ratio (95% CI)
LDL-C
2.73(2.34–3.20)
LDL-CLp(a)corr30
2.51(2.15–2.93)
LDL-CLp(a)corr17.3
2.64(2.26–3.10)
Observational data: associations, not effects.
Further findings
Incident CHD with uncorrected LDL-C, by Lp(a) mass (subgroup)
| Comparison | subdistribution HR (95% CI) | |
|---|---|---|
| LDL-C, Lp(a) ≥90th percentile · top vs bottom fifth | 4.38 (2.08–9.22) | |
| LDL-C, Lp(a) <90th percentile · top vs bottom fifth | 2.60 (2.21–3.07) | |
| 0.10.31310Subdistribution hazard ratio (log scale) |
Incident CHD with apoB, by Lp(a) mass (subgroup)
| Comparison | subdistribution HR (95% CI) | |
|---|---|---|
| apoB, Lp(a) ≥90th percentile | 2.43 (1.34–4.40) | |
| apoB, Lp(a) <90th percentile | 3.34 (2.78–4.01) | |
| 0.20.5125Subdistribution hazard ratio (log scale) |
- Incident CHD with uncorrected LDL-C, by Lp(a) mass (subgroup): Pinteraction0.39
- Incident CHD with apoB, by Lp(a) mass (subgroup): Pinteraction0.49
Original publication
Impact of Lipoprotein(a) Level on Low-Density Lipoprotein Cholesterol– or Apolipoprotein B–Related Risk of Coronary Heart Disease. J Am Coll Cardiol. Published 9 July 2024. doi:10.1016/j.jacc.2024.04.050
Summarised from the published abstract; every number is checked against it