OBJECTIVES: Elevated lipoprotein(a) [Lp(a)] is an independent, inherited risk factor for atherosclerotic cardiovascular disease (ASCVD). Guidelines now recommend Lp(a) measurement at least once per lifetime for all adults. The aim of this study was to characterize the impact of elevated Lp(a) on the risk of first and recurrent major adverse cardiovascular events (MACE).

METHODS: This UK Biobank study included a primary prevention cohort of 441,896 individuals with an Lp(a) measurement and no ASCVD diagnosis. Associations of serum Lp(a) levels with incidence of and time to first MACE (defined as myocardial infarction [MI], ischemic stroke [IS], and CV death) were calculated, and adjusted for age, sex, and ethnicity.

RESULTS: Five percent of the cohort experienced a MACE (3% MI, 1% IS, 1% CV death). Incidence rates (IR per 100 person years) of first MACE increased with Lp(a) levels; IR increased from 0.432 in the Lp(a) <105 nmol/L category by 15.5%-82% in Lp(a) ≥105 nmol/L categories.

A 100 nmol/L increase in Lp(a) was associated with an increased risk of first MACE (18%), MI (24%), IS (8%) and CV death (9%). When compared to Lp(a) <105 nmol/L, risk of first MACE increased from 17% up to 91% with increasing Lp(a) categories ≥105 nmol/L.

Elevated Lp(a) was associated with increased risk of recurrent MACE. In the Lp(a) <105 nmol/L category, 0.7% individuals had 2 and 1% had 3+ events. In Lp(a) ≥105 nmol/L categories, the percentage of individuals with 2 events ranged from 0.9-1.3%, and from 1.3-2.5% for those with 3+ events.

CONCLUSIONS: Individuals with elevated Lp(a) are more likely to have a first and recurrent MACE. Lp(a) screening should be considered when discerning cardiovascular primary risk prediction as part of clinical practice.