Lipoprotein(a), C-Reactive Protein, and Cardiovascular Risk in Primary and Secondary Prevention Populations
Authors' conclusion
In this study, higher levels of Lp(a) were associated with MACE, MI, and PAD in both primary and secondary prevention populations regardless of baseline hs-CRP value.
Study context
- Population
- Primary prevention (UK Biobank, without prevalent atherosclerotic cardiovascular disease (ASCVD)) and secondary prevention (FOURIER and SAVOR-TIMI 53 trials) populations with baseline Lp(a) and high-sensitivity C-reactive protein (hs-CRP)UK Biobank 357,220
- Exposure
- Lp and CV risk by baseline hs-CRP
- Outcome
- MACE (CV death, MI or ischemic stroke), individual MACE components and PAD, per 50-nmol/L higher Lp(a)
Methodological details3 cohorts: 1 population-based cohort, 2 randomised clinical trials
- 3 cohorts: 1 population-based cohort, 2 randomised clinical trials
Main finding
As reported in the abstract
MACE per 50-nmol/L higher Lp(a), primary prevention (UK Biobank)
Hazard ratio (95% CI)P value
High hs-CRP
1.05(1.04–1.07)
P < 0.001Low hs-CRP
1.05(1.04–1.07)
P < 0.001Per 50-nmol/L higher Lp, as printed
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| MACE per 50-nmol/L higher Lp(a), secondary prevention (FOURIER and SAVOR) — High hs-CRP · per 50-nmol/L higher Lp(a) · aggregated data from FOURIER and SAVOR | 1.02 (1.00–1.05) | P = 0.04 | |
| MACE per 50-nmol/L higher Lp(a), secondary prevention (FOURIER and SAVOR) — Low hs-CRP · per 50-nmol/L higher Lp(a) · aggregated data from FOURIER and SAVOR | 1.05 (1.02–1.08) | P < 0.001 | |
| 0.512Hazard ratio (log scale) |
- Major adverse cardiovascular events (MACE) per 50-nmol/L higher Lp(a), secondary prevention (FOURIER and SAVOR): P = .16 for interaction
MACE per 50-nmol/L higher Lp(a), secondary prevention (FOURIER and SAVOR)
- Higher Lp(a) also associated with MI and peripheral artery disease (PAD)
Original publication
Lipoprotein(a), C-Reactive Protein, and Cardiovascular Risk in Primary and Secondary Prevention Populations. JAMA Cardiol. Published 1 April 2024. doi:10.
Summarised from the published abstract; every number is checked against it