October 13, 2012Open Access

Lipoprotein(a) and Risk of Coronary, Cerebrovascular, and Peripheral Artery Disease

Q: What does this research mean for the field?

Lipoprotein(a) levels are associated with a 37% increased risk of peripheral artery disease and coronary artery disease but not with ischemic stroke. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

Lipoprotein(a) levels were associated with a 37% increased risk of peripheral artery disease and coronary artery disease but not with ischemic stroke.

Structured PICO

Does elevated Lipoprotein(a) increase the risk of peripheral arterial disease, coronary artery disease, and stroke in apparently healthy individuals?

Population

Apparently healthy participants in the European Prospective Investigation of Cancer (EPIC)-Norfolk cohort

Intervention

Elevated Lipoprotein(a) levels

Outcome

Incident peripheral arterial disease (PAD), coronary artery disease (CAD), and ischemic strokehard clinical

Elevated Lipoprotein(a) is an independent risk factor for future peripheral artery disease and coronary artery disease events, and this risk is not modified by LDL cholesterol levels.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Objective— Although the association between circulating levels of lipoprotein(a) Lp(a) and risk of coronary artery disease (CAD) and stroke is well established, its role in risk of peripheral arterial disease (PAD) remains unclear. Here, we examine the association between Lp(a) levels and PAD in a large prospective cohort. To contextualize these findings, we also examined the association between Lp(a) levels and risk of stroke and CAD and studied the role of low-density lipoprotein as an effect modifier of Lp(a)-associated cardiovascular risk. Methods and Results— Lp(a) levels were measured in apparently healthy participants in the European Prospective Investigation of Cancer (EPIC)-Norfolk cohort. Cox regression was used to quantify the association between Lp(a) levels and risk of PAD, stroke, and CAD outcomes. During 212 981 person-years at risk, a total of 2365 CAD, 284 ischemic stroke, and 596 PAD events occurred in 18 720 participants. Lp(a) was associated with PAD and CAD outcomes but not with ischemic stroke (hazard ratio per 2.7-fold increase in Lp(a) of 1.37, 95% CI 1.25–1.50, 1.13, 95% CI 1.04–1.22 and 0.91, 95% CI 0.79–1.03, respectively). Low-density lipoprotein cholesterol levels did not modify these associations. Conclusion— Lp(a) levels were associated with future PAD and CAD events. The association between Lp(a) and cardiovascular disease was not modified by low-density lipoprotein cholesterol levels.