Lipoprotein(a) and risk of cardiovascular disease events: an analysis in a large US national database

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New Insights on Lipoprotein(a) and Cardiovascular Risk: Family Heart Foundation Presents Groundbreaking Research at AHA 2024

The Family Heart Foundation presented new findings on lipoprotein(a) [Lp(a)] and its connection to cardiovascular disease (CVD) risk at the American Heart Association (AHA) Scientific Sessions in Chicago, IL. This large analyses of Lp(a) data, shares critical insights into the impact of Lp(a) on cardiovascular health.

View the #AHA24 poster presentation, graphics to download and share on your channels, and video of the event.

Lipoprotein(a) is an independent, genetically determined factor that heightens the risk of atherosclerotic cardiovascular disease (ASCVD). Despite growing awareness of Lp(a)’s prevalence, screening rates remain low, leaving a significant gap in cardiovascular risk assessment and patient care. The Family Heart Foundation aims to bridge this gap by examining the correlation between Lp(a) levels and CVD events in real-world patient populations.

The aim of this retrospective cohort study was to evaluate the association of Lp(a) level with cardiovascular disease (CVD) events in individuals with and without pre-existing ASCVD using real-world data from the Family Heart Database.

Family Heart Database is comprised of medical claims (diagnostic, procedural and prescription) data and/or laboratory data for >324 million individuals with CVD diagnosis or assessment in the US from 2012 to 2021, including more than 140 million individuals with 7 to 10 years of medical claims data.

Key selection criteria for this dataset:

  • ≥18 years
  • ≥1 Lp(a) test measured in nmol/L during May 1, 2013 to December 31, 2020, and
  • ≥1 medical claim pre- and post-index date (date of earliest Lp[a] test).

Data and Statisitical Analysis:

Lp(a) levels were categorized by percentile (<20th, 20ᵗʰ to 80ᵗʰ, and >80ᵗʰ). Multivariable Cox Proportional Hazards model analyses compared a group with Lp(a) <20ᵗʰ percentile [<10 nmol/L] and no ASCVD to five other groups that differed by pre-index ASCVD status (Yes/No) and category of Lp(a) level.

This is one of the largest analyses of US individuals with Lp(a) levels to date (n=392,835), using real-world data from the Family Heart Database. In this extensive cohort, elevated Lp(a) levels were consistently associated with an increased risk of CVD events, regardless of a history of ASCVD. The key takeaways include:

  • Elevated Lp(a) consistently predicted increased risk of future CVD.
  • Individuals without ASCVD at baseline showed a 12% (adjusted HR) increased risk of CVD events with Lp(a) levels >140 nmol/L over a follow-up period of 2.5 years.
  • Individuals with ASCVD and elevated Lp(a) >140 nmol/L also demonstrated increased risk.

These findings highlight the substantial unmet need for wide-spread Lp(a) screening in individuals with and without ASCVD.

Only 1.1% of all adults were screened between 2012 and 2021

In adults with ASCVD, 2.0% were screened

Annually, screening increased substantially after 2018, but remained low overall.

Additional research and effort is needed to address the barriers and facilitators of lp(a) screening.

Widespread Need for Lp(a) Screening: Findings reveal a strong, unmet need for Lp(a) screening to improve risk stratification and support proactive cardiovascular care.

The study highlights the necessity of including Lp(a) testing in standard cardiovascular risk assessments. With its strong correlation to CVD outcomes, Lp(a) can serve as a key factor in identifying at-risk patients and tailoring preventive measures. Integrating Lp(a) screening into routine care would provide healthcare providers with crucial data to develop personalized care plans.

For more details on our research and how you can support efforts to promote Lp(a) screening, view our Lp(a) resources.

Poster Presentation Authors: Diane E MacDougall, Mary P McGowan, Xingdi Hu, Wess Boatwright, Theresa Stern, Bonnie Hartsuff, Katherine A Wilemon

Presented on Saturday, November 16th, 2024 at American Heart Association Scientific Sessions in Chicago, IL.

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