What is the clinical evidence from this study?

Study design: Cohort. Population: Coronary heart disease (n=530). Intervention: Elevated Lipoprotein(a) vs. Low Lipoprotein(a) (<300 mg/L). Primary outcome: Major Adverse Cardiovascular Events (MACE) (HR 2.07, 95% CI 1.37-3.12, p=0.001).

What does this research mean for the field?

Elevated Lipoprotein(a) significantly increases the risk of major adverse cardiovascular events in coronary heart disease patients, with this risk being particularly amplified in those with elevated homocysteine levels. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To explore the relationship between elevated Lp(a) levels and recurrent cardiovascular events across different homocysteine concentrations in coronary heart disease patients.

April 18, 2026Open Access

Correlation between elevated Lp(a) levels and cardiovascular risk in coronary heart disease patients with different homocysteine concentrations

Q: What are the key findings of this study?

Elevated Lipoprotein(a) significantly increased the risk of major adverse cardiovascular events (HR 2.07) in coronary heart disease patients, especially those with elevated homocysteine levels.

Q: What does this research mean for the field?

Elevated Lipoprotein(a) significantly increases the risk of major adverse cardiovascular events in coronary heart disease patients, with this risk being particularly amplified in those with elevated homocysteine levels. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To explore the relationship between elevated Lp(a) levels and recurrent cardiovascular events across different homocysteine concentrations in coronary heart disease patients.

Key Result

Elevated Lipoprotein(a) significantly increased the risk of major adverse cardiovascular events (HR 2.07) in coronary heart disease patients, especially those with elevated homocysteine levels.

Key Points

To explore the relationship between elevated Lp(a) levels and recurrent cardiovascular events across different homocysteine concentrations in coronary heart disease patients.
Conducted a 36-month follow-up study on 530 coronary heart disease patients.
Divided patients into low-Lp(a) and high-Lp(a) groups.
Compared incidence of major adverse cardiovascular events and acute coronary events.
Analyzed data using Kaplan-Meier curves and Cox proportional hazards models.
Assessed associations of Lp(a) with risk based on homocysteine levels.
Elevated Lp(a) was associated with a higher risk of MACE (HR = 2.07) and ACE (HR = 2.83) overall.
In patients with moderate-to-high homocysteine levels, elevated Lp(a) significantly increased the risk of MACE and ACE.
No significant association was detected between elevated Lp(a) and cardiovascular events in patients with low homocysteine levels.

Study Design

Type

Cohort (n=530)

Multicenter

Structured PICO

Does elevated Lp(a) increase the risk of MACE and ACE in CAD patients, and is this risk modified by homocysteine concentrations?

Population

530 patients with coronary artery disease (CAD) who underwent coronary arteriography, mean age 65 years, 231 males and 299 females, based in Shanghai, China. Inclusion criteria: met ACS diagnostic criteria, complete follow-up data, expected survival >3 years. Exclusion criteria: organic heart disease, COPD, renal insufficiency, iodine allergy.

Intervention

High Lipoprotein(a) [Lp(a)] levels (≥300 mg/L). All patients received standard postoperative drug therapy including dual antiplatelet therapy (aspirin and clopidogrel or ticagrelor) and lipid-lowering therapy (rosuvastatin 10 mg or atorvastatin 20 mg).

Comparator

Low Lipoprotein(a) [Lp(a)] levels (<300 mg/L). All patients received standard postoperative drug therapy including dual antiplatelet therapy (aspirin and clopidogrel or ticagrelor) and lipid-lowering therapy (rosuvastatin 10 mg or atorvastatin 20 mg).

Outcome

Major Adverse Cardiovascular Events (MACE), defined as a composite of cardiac death, non-fatal myocardial infarction, ischemic stroke, and unplanned coronary revascularization at 36 months follow-up.composite

Elevated Lp(a) significantly increases the risk of recurrent cardiovascular events in CAD patients, but this risk is amplified by moderate-to-high homocysteine levels and attenuated when homocysteine is low.

Main Result

Effect estimate: HR 2.07 (95% CI 1.37-3.12)

p-value: p=0.001

Limitations

Single-center retrospective investigation carrying selection bias
Folate/vitamin B12 levels were not measured, making it impossible to rule out their influence on HCY
Insufficient sample size with limited statistical power
Specific interaction mechanism between Lp(a) and HCY remains to be further elucidated through laboratory studies

Abstract

In recent years, the impact of lipoprotein(a) (Lp(a)) on the prognosis of coronary heart disease has been increasingly recognized. Lp(a) is an independent risk factor for cardiovascular disease, and studies have shown that homocysteine (HCY) may influence the association between Lp(a) and the risk of recurrent cardiovascular events. This study investigates the association between Lp(a) levels and recurrent cardiovascular events in patients with varying HCY concentrations. We conducted a 36-month follow-up on 530 patients with coronary heart disease and divided them into low-Lp(a) and high-Lp(a) groups based on Lp(a) levels. The incidence rates of major adverse cardiovascular events (MACE) and acute coronary events (ACE) were compared between the two groups. The association between elevated Lp(a) and cardiovascular risk in different subgroups(based on HCY concentration) was analyzed using Kaplan-Meier curves and Cox proportional hazards models. Elevated Lp(a) remained a significant risk factor for both MACE (HR = 2.07, 95% CI = 1.37–3.12, P = 0.001) and ACE (HR = 2.83, 95% CI = 1.67–4.81, P = 0.001) overall. In subgroup analyses, elevated Lp(a) in patients with moderate-to-high HCY levels constituted a high-risk cohort for MACE and ACE occurrence (HR = 1.87, 95% CI = 1.01–3.46, P = 0.046;HR = 2.85, 95% CI = 1.32–6.18, P = 0.008). Among those with low HCY levels, elevated Lp(a) showed no association with either MACE or ACE (P > 0.05). When HCY is elevated, patients with increased Lp(a) experience amplified risk of recurrent cardiovascular events. This association shifts when HCY is at low levels. Future efforts should emphasize combined assessment of Lp(a) and HCY and explore targeted intervention strategies to reduce residual cardiovascular risk.

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