Risks of Incident Cardiovascular Disease Associated With Concomitant Elevations in Lipoprotein(a) and Low‐Density Lipoprotein Cholesterol—The Framingham Heart Study

• DOI: 10.1161/jaha.119.014711
• Publication Date: 2020-09-06T09:01:47Z
• Authors: Mehdi Afshar; Jian Rong; Yang Zhan; Hao Yu Chen; James C. Engert; Allan D. Sniderman; Martin G. Larson; Ramachandran S. V...; George Thanassoulis
• Keywords: Lipoprotein(a); High-density lipoprotein; Framingham Heart Study

Background Elevated lipoprotein(a) is a well‐established risk factor for atherosclerotic vascular disease but not measured in routine clinical care. Screening of high individuals with moderate elevations low‐density lipoprotein cholesterol (LDL‐C) may identify at cardiovascular disease. Methods and Results We examined 2606 Framingham Offspring participants (median age, 54 years; 45% men) prospectively median follow‐up 15 years (n=392 incident events). Individuals higher (≥100 nmol/L) versus lower were divided into groups based on LDL‐C <135 mg/dL ≥135 mg/dL. In Cox models, after adjustment known factors, each significant predictors (LDL‐C mg/dL: hazard ratio [HR], 1.34; 95% CI, 1.09–1.64; P =0.006; (a): HR, 1.31; 1.03–1.66; =0.026). Across the high/low (a) or mg/dL, absolute risks 22.6% (high lipoprotein(a)/LDL‐C n=248), 17.3% (low n=758), 12.7% n=275) 11.5% n=1328, reference group). Among those had 43% (HR, 1.43; 1.05–1.97; =0.02). Presence levels (135–159 mg/dL) yielded equivalent to ≥160 (23.5%, 17.4%–31.3%; 20.7%, 16.8%–25.3%, respectively). Conclusions Concomitant elevation ≥100 nmol/L associated measurement LDL‐C, who do otherwise meet criteria statins, risk.