Lipoprotein(a) and residual cardiovascular risks in Japanese patients with coronary artery disease who achieve guideline-recommended low-density lipoprotein cholesterol goals
Authors' conclusion
Whilst lower achieved LDL-C attenuates in part the risk from Lp(a), elevated Lp(a) levels still associate with worse cardiovascular outcomes.
Study context
- Population
- Japanese patients with coronary artery disease (CAD) after PCI, stratified by low-density lipoprotein cholesterol (LDL-C) 8 weeks after PCI
- Participants
- 1,581 patients
- Exposure
- Lp levels by achieved LDL-C strata
- Outcome
- MACE:
- Cardiac death
- Non-fatal MI
- Coronary revascularization in non-culprit segments
- Follow-up
- 5.1-year observation
Methodological detailsmulticentre
- Multicentre
Main finding
As reported in the abstract
MACE in patients with LDL-C <55 mg/dL (n=512) · 5.1 years
Lp(a) <30 mg/dL
- Major adverse cardiovascular events (MACE)
- 1.4 events per 100 person-years
- Standardized 5-year MACE rate
- 5.0%
Lp(a) ≥30 and <50 mg/dL
- MACE
- 4.7 events per 100 person-years
- Standardized 5-year MACE rate
- 17.0%
Lp(a) ≥50 mg/dL
- MACE
- 7.5 events per 100 person-years
- Standardized 5-year MACE rate
- 33.4%
Major adverse cardiovascular events (MACE)
Lp(a) <30 mg/dL1.4 events per 100 person-years
Lp(a) ≥30 and <50 mg/dL4.7 events per 100 person-years
Lp(a) ≥50 mg/dL7.5 events per 100 person-years
Standardized 5-year MACE rate
Lp(a) <30 mg/dL5.0%
Lp(a) ≥30 and <50 mg/dL17.0%
Lp(a) ≥50 mg/dL33.4%
Each group vs Lp(a) <30 mg/dLAdjusted hazard ratio (95% CI)P value
Lp(a) ≥30 and <50 mg/dL
3.80(1.78–8.11)
P < 0.001Lp(a) ≥50 mg/dL
6.90(3.53–13.46)
P < 0.001- Trend across Lp(a) levels (LDL-C <55 mg/dL)
- P < 0.001
Observational data: associations, not effects.
Further findings
Events per 100 person-years
| Outcome | Lp(a) <30 mg/dL | Lp(a) ≥30 and <50 mg/dL | Lp(a) ≥50 mg/dL |
|---|---|---|---|
| MACE in patients with LDL-C ≥55 mg/dL (n=1069) · 5.1 years | |||
| MACE | 3.9 | 7.9 | 11.0 |
- MACE in patients with LDL-C ≥55 mg/dL (n=1069) — Log-rank trend across Lp(a) levels
- p<0.001
- MACE in patients with LDL-C ≥55 mg/dL (n=1069): MACE overall 21.3%
ROC threshold of Lp(a) for MACE
- Lp(a) threshold
- ≥28.2 mg/dL
- AUC
- 0.68 (p<0.001)
Original publication
Lipoprotein(a) and residual cardiovascular risks in Japanese patients with coronary artery disease who achieve guideline-recommended low-density lipoprotein cholesterol goals. Eur Heart J. Published 24 May 2026. doi:10.
Summarised from the published abstract; every number is checked against it