Prevention & lipidsCohort study
Lipoprotein(a), C-Reactive Protein, and Cardiovascular Risk in Primary and Secondary Prevention Populations
- Cohort study
- 3 cohorts: 1 population-based cohort, 2 randomised clinical trials
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)
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:10.1001/jamacardio.2023.5605
Summarised from the published abstract; every number is checked against it