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May 23, 2026Journal of Lipid and AtherosclerosisOpen Access

Association of Smoking Status and Urinary Cotinine Levels With Lipoprotein(a) in Korean Adults

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Key result

Cotinine-verified smoking linked to ~5% lower odds of high Lp(a) versus non-smoking.

  • OR 0.946
  • 95% CI 0.910-0.982
  • P=0.005
  • n=146,129

Why the study?

Although lipoprotein(a) is primarily genetically regulated, the impact of modifiable factors like smoking on its concentrations remains unclear, particularly when assessed using objective biomarkers like urinary cotinine.

Is smoking status associated with serum Lipoprotein(a) concentrations in Korean adults?

Population

146,129 participants from the Kangbuk Samsung Health Study

Comparison

Smoking status by self-report and urinary cotinine levels

Design

Cross-sectional study

Authors

BKB KimKangbuk Samsung HospitalYJYoungwoo JangGachon UniversityJKJeonggyu KangKangbuk Samsung Hospital

Discussion

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Implication

No clinical action warranted from smoking-Lp(a) link; leaves causality and CV relevance open for prospective study.

Key Points

  • This study investigates the relationship between smoking status and LP(a) concentrations in Korean adults using urinary cotinine as a biomarker.
  • Analyzed data from 146,129 participants in the Kangbuk Samsung Health Study (2011-2013).
  • Defined smoking status via self-report and urinary cotinine levels, measuring LP(a) using an immunoturbidimetric assay.
  • Performed multivariable regression analyses adjusting for relevant covariates.
  • Median LP(a) level was 23.3 mg/dL; 16.0% of participants had high LP(a) defined as ≥50 mg/dL.
  • Current smokers had significantly lower LP(a) levels than non-smokers (p<0.001).
  • Urinary cotinine inversely correlated with LP(a) concentrations (=-0.147, p<0.001) showing a dose-dependent trend.

Study Design

Type

Cross-Sectional (n=146,129)

Multicenter

No

Structured PICO

Is smoking status associated with serum Lipoprotein(a) concentrations in Korean adults?

P
Population
146,129 Korean adults (mean age 37.1 years, 59.2% men) from the Kangbuk Samsung Health Study (2011-2013).
I
Intervention
Current smoking (defined by self-report and urinary cotinine ≥50 ng/mL)
C
Comparator
Non-smokers
O
Outcome
Serum Lipoprotein(a) concentrationssurrogate

Main Result

Effect estimate: OR 0.946 (95% CI 0.910-0.982)

Absolute Event Rate: 13.9% vs 16.7%

p-value: p=0.005

Smoking status, verified by both self-report and urinary cotinine, is inversely associated with serum Lipoprotein(a) levels in Korean adults.

Limitations

  • Cross-sectional design precludes causal inference
  • Single ethnic group limits generalizability
  • Residual confounding from unmeasured lifestyle or dietary factors
  • Genetic determinants of LP(a) were not assessed
  • Urinary cotinine does not fully account for interindividual variation in nicotine metabolism
  • Causality cannot be established due to the cross-sectional design

Cite This Study

Kim et al. (2026) conducted a cross-sectional in General population (n=146,129). Cotinine-verified smoking vs. Cotinine-verified non-smoking was evaluated on High Lipoprotein(a) (≥50 mg/dL) (OR 0.946, 95% CI 0.910-0.982, p=0.005). Cotinine-verified smoking was significantly associated with reduced odds of high lipoprotein(a) levels compared to non-smoking (OR 0.946).

synapsesocial.com/papers/6a1143fc48a409a3a49de857https://doi.org/10.12997/jla.2026.15.2.317
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