Discrimination and Net Reclassification of Cardiovascular Risk With Lipoprotein(a)

Willeit, Peter; Kiechl, Stefan; Kronenberg, Florian; Witztum, Joseph L.; Santer, Peter; Mayr, Manuel; Xu, Qingbo; Mayr, Agnes; Willeit, Johann; Tsimikas, Sotirios

doi:10.1016/j.jacc.2014.03.061

Cited by 247 publications

(140 citation statements)

References 37 publications

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“…The values assigned to the calibrators were validated by both the Diasorin (Stillwater, MN) and Technoclone (Vienna, Austria) calibrators. This assay correlates well with commercially available Lp(a) assays, has a coefficient of variability of 3-5%, and has been used in more than 20 studies and 20,000 patients ( 13,(16)(17)(18)(19).…”

Section: Discussionmentioning

confidence: 71%

Population and assay thresholds for the predictive value of lipoprotein (a) for coronary artery disease: the EPIC-Norfolk Prospective Population Study

Verbeek

Boekholdt

Stoekenbroek

et al. 2016

Journal of Lipid Research

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Section: Discussionmentioning

confidence: 71%

Population and assay thresholds for the predictive value of lipoprotein (a) for coronary artery disease: the EPIC-Norfolk Prospective Population Study

Verbeek

Boekholdt

Stoekenbroek

et al. 2016

Journal of Lipid Research

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“…Nonetheless, the European Atherosclerotic Society consensus panel as well as the National Lipid Association recommends measuring Lp(a) in patients with early‐onset ACS, a family history of early ACS, or who are at intermediate risk (ie, 10–20% 10‐year risk) for cardiovascular events 1. This approach is supported by recent data suggesting that Lp(a) may reclassify intermediate risk individuals to high risk,31 especially when Lp(a) levels are very high (>95% percentile) 5, 32. Our results suggest that in addition to these groups, Lp(a) screening should also be recommended for individuals with LDL‐C >3.5 mmol/L, as the presence of both high LDL‐C and high Lp(a) may accelerate progression of vascular disease and markedly increase the risk of cardiovascular events.…”

Section: Discussionmentioning

confidence: 99%

Lipoprotein(a) Interactions With Low‐Density Lipoprotein Cholesterol and Other Cardiovascular Risk Factors in Premature Acute Coronary Syndrome (ACS)

Afshar

Pilote

Dufresne

et al. 2016

JAHA

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BackgroundCurrent recommendations for lipoprotein(a) (Lp[a]) focus on the control of other risk factors, including lowering low‐density lipoprotein cholesterol (LDL‐C), with little evidence to support this approach. Identifying interactions between Lp(a) and other risk factors could identify individuals at increased risk for Lp(a)‐mediated disease.Methods and ResultsWe used a case‐only study design and included 939 participants (median age=49 years, interquartile range 46–53, women=33.1%) from the GENdEr and Sex determInantS of cardiovascular disease: from bench to beyond‐Premature Acute Coronary Syndrome (GENESIS‐PRAXY) study, a multicenter prospective cohort study of premature acute coronary syndrome. There was a higher prevalence of elevated Lp(a) levels (>50 mg/dL; 80th percentile) in PRAXY participants as compared to the general population (31% versus 20%; P<0.001). Lp(a) was strongly associated with LDL‐C (adjusted β 0.17; P<0.001). Individuals with high Lp(a) were more likely to have LDL‐C >2.5 mmol/L, indicating a synergistic interaction (adjusted odds ratio 1.51; 95% CI 1.08–2.09; P=0.015). The interaction with high Lp(a) was stronger at increasing LDL‐C levels (LDL‐C >3.5, adjusted odds ratio 1.87; LDL‐C >4.5, adjusted odds ratio 2.72). In a polytomous logistic model comparing mutually exclusive LDL‐C categories, the interaction with high Lp(a) became attenuated at LDL‐C ≤3.5 mmol/L (odds ratio 1.16; 95% CI 0.80–1.68, P=0.447). Other risk factors were not associated with high Lp(a).ConclusionsIn young acute coronary syndrome patients, high Lp(a) is more prevalent than in the general population and is strongly associated with high LDL‐C, suggesting that Lp(a) confers greater risk for acute coronary syndrome when LDL‐C is elevated. Individuals with high Lp(a) and LDL‐C >3.5 mmol/L may warrant aggressive LDL‐C lowering.

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“…Lp(a) concentrations for CVD events (60). It was speculated that the discordance between the two studies may be explained by increased statin use among subjects with smaller Lp(a) isoforms.…”

Section: Downloaded Frommentioning

confidence: 99%

Lipoprotein (a): truly a direct prothrombotic factor in cardiovascular disease?

Boffa

Koschinsky

2016

Journal of Lipid Research

207

125

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Discrimination and Net Reclassification of Cardiovascular Risk With Lipoprotein(a)

Abstract: Elevated Lp(a) predicts 15-year CVD outcomes and improves CVD risk prediction. These findings suggest that Lp(a) levels may be used in risk assessment of subjects in the general community, particularly in intermediate-risk groups.

Cited by 247 publications

References 37 publications

Population and assay thresholds for the predictive value of lipoprotein (a) for coronary artery disease: the EPIC-Norfolk Prospective Population Study

Population and assay thresholds for the predictive value of lipoprotein (a) for coronary artery disease: the EPIC-Norfolk Prospective Population Study

Lipoprotein(a) Interactions With Low‐Density Lipoprotein Cholesterol and Other Cardiovascular Risk Factors in Premature Acute Coronary Syndrome (ACS)

Lipoprotein (a): truly a direct prothrombotic factor in cardiovascular disease?

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