Baseline and on-statin treatment lipoprotein(a) levels for prediction of cardiovascular events: individual patient-data meta-analysis of statin outcome trials

This analysis of data from 7 statin outcome trials found a linear association between lipoprotein(a) concentrations and cardiovascular risk, which is evident at concentrations of 30mg/dL to <50mg/dL, pronounced at concentrations ≥50 mg/dL, and persists despite statin treatment.

The authors of a related comment note that there are epidemiological data supporting lipoprotein(a) as an independent risk factor for atherosclerotic cardiovascular disease. However its contribution to risk in patients with established atherosclerotic cardiovascular disease receiving guideline-recommended treatments remains uncertain.

 

Across the trials (n=29,069), statin therapy lowered plasma LDL cholesterol by 39% without changing plasma lipoprotein(a) concentrations. The association of lipoprotein(a) with atherosclerotic cardiovascular disease was stronger on statins than on placebo (p=0.010). The researchers conclude that patients with increased amounts of lipoprotein(a) and receiving statin therapy have increased residual risk of atherosclerotic cardiovascular disease, and that this provides a rationale for testing the lipoprotein(a) lowering hypothesis in cardiovascular disease outcomes trials.