Prevalence of Elevated Lipoprotein(a) and its Association With Subclinical Atherosclerosis in 2.9 Million Chinese Adults

BACKGROUND Elevated lipoprotein(a) Lp(a) is strongly associated with an increased risk of atherosclerotic cardiovascular disease; yet, large-scale studies on the epidemiology of elevated Lp(a) as well as its association with subclinical atherosclerosis in the Chinese population are limited. OBJECTIVES This study aimed to estimate the prevalence of elevated Lp(a) in a large check-up population of China, and investigate its associations with both site-specific and multisite subclinical atherosclerosis. METHODS Adults who underwent Lp(a) testing between 2017 and 2023 at Meinian health check-up centers in 30 provinces of China were included. Because the test results of Lp(a) were reported in either the mass unit (mg/dL) or the molar unit (nmol/L) and conversion between units was not recommended, separate analyses were conducted for each unit. Subclinical atherosclerosis was assessed using various imaging examinations at the carotid artery, the brain, and the coronary artery. The prevalence of elevated Lp(a) was estimated across the overall study population and various subpopulations. The logistic regression model was used to investigate the associations between elevated Lp(a) and subclinical atherosclerosis. RESULTS A total of 2,788,206 and 167,114 participants with the mass unit and the molar unit were included. In the mass unit group, the prevalence of Lp(a) >30 and >50 mg/dL was 18.67% and 8.41%, respectively. Significantly higher prevalence was observed among women, elderly individuals, and individuals with various cardio-renal-metabolic risk factors (all P 30 to ∼50 mg/dL exhibited 11%, 15%, 9%, and 11% greater odds of increased carotid intima-media thickness, carotid plaque, subclinical brain infarcts, and coronary artery calcification, respectively. The odds were even higher for those with Lp(a) >50 mg/dL. Furthermore, elevated Lp(a) was significantly associated with the extent of coronary artery calcification, as well as subclinical atherosclerosis at 1, 2, and 3 sites, with the association being more pronounced in cases with severe extent and multisite involvement. These results were similar in the molar unit group. CONCLUSIONS A significant burden of elevated Lp(a) was found in China, highlighting the necessity of prioritized Lp(a) screening in high-risk groups. Elevated Lp(a) was identified as a significant risk factor for site-specific subclinical atherosclerosis, with stronger associations observed in severe extent and multisite involvement. Our findings suggest that individuals with elevated Lp(a) should undergo a comprehensive assessment of subclinical atherosclerosis at multiple sites to help prevent ASCVD.