Key result
Elevated Lp(a) ≥50 mg/dL linked to ~11% greater risk of incident AF.
Why the study?
Although lipoprotein(a) is a known risk factor for atherosclerotic cardiovascular disease, its role in the development of AF independent of this association remains unclear.
Does elevated lipoprotein(a) (≥50 mg/dL) increase the risk of incident atrial fibrillation in adult patients without prior AF?
Cohort (n=75,376)
Yes
Does elevated lipoprotein(a) (≥50 mg/dL) increase the risk of incident atrial fibrillation in adult patients without prior AF?
Effect estimate: adjusted HR 1.11 (95% CI 1.05-1.18)
Absolute Event Rate: 14% vs 12%
p-value: p=<0.001
Elevated lipoprotein(a) levels (≥50 mg/dL) are independently associated with an increased risk of developing new-onset atrial fibrillation.
Elevated Lp(a) supports AF risk stratification in observational cohorts; leaves open causal role and need for prospective trials.
AIMS: Atrial fibrillation (AF) is the most common cardiac arrhythmia. Although lipoprotein(a) [Lp(a)] is known to be a well-established risk factor for atherosclerotic cardiovascular disease, its role in the development of AF, independent of this association, remains unclear. METHODS AND RESULTS: Adult patients from the three Mayo Clinic sites with a baseline Lp(a) and without AF history were included. Patients were categorized into two groups based on their Lp(a) levels: high Lp(a) (≥50 mg/dL) and low Lp(a) (<50 mg/dL). Survival probabilities free from incident AF were compared between Lp(a) groups, during a follow-up period up to 15 years, using the Kaplan-Meier curve and the log-rank test. Multivariable Cox regression analysis was also conducted. A total of 75 376 patients were included (median age: 55 years, 59% males), with a median follow-up duration of 8.8 (inter-quartile range: 3.4, 14.8) years. Incident AF was detected in 5738 (7.6%) patients. Survival probability free from incident AF was significantly lower in patients with elevated Lp(a) (86%) compared with those with low Lp(a) (88%, log-rank P < 0.001). Multivariable analysis adjusted for potential risk factors of AF showed a statistically significant association of elevated Lp(a) with an 11% increase in AF risk (adjusted hazard ratio: 1.11, 95% confidence interval: 1.05-1.18). CONCLUSION: Our study suggests that elevated Lp(a) (≥50 mg/dL) is an independent risk factor for incident AF. Future prospective studies are warranted to validate our results and to test if reducing Lp(a) could mitigate the burden of AF.
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Awad et al. (2025) conducted a cohort in Atrial fibrillation (n=75,376). Elevated lipoprotein(a) (≥50 mg/dL) vs. Low lipoprotein(a) (<50 mg/dL) was evaluated on Incident atrial fibrillation (adjusted HR 1.11, 95% CI 1.05-1.18, p=<0.001). Elevated lipoprotein(a) ≥50 mg/dL was associated with a significantly increased risk of incident atrial fibrillation compared to levels <50 mg/dL (adjusted HR 1.11; 95% CI 1.05-1.18; P<0.001).
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