August 1, 2026Journal of the American College of Cardiology
Extreme Lipoprotein(a) Levels and Improved Cardiovascular Risk Prediction
Key result
Adding extreme Lp(a) levels improves MI risk prediction with a ~16% net reclassification improvement.
- NRI +16%
- 95% CI 8% to 24%
- n=8,720
Why the study?
Does the addition of extreme lipoprotein(a) levels or LPA risk genotypes improve MI and CHD risk prediction beyond conventional risk factors in a general population?
Population
8,720 Danish participants in a general population study
Comparison
Risk prediction including extreme lipoprotein… vs Conventional risk prediction models
Design
Cohort
Follow-up
1991-1994 through 2011
Authors
Discussion
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Member takes
Implication
Extreme lipoprotein(a) levels and corresponding LPA risk genotypes significantly improve risk prediction and reclassification for myocardial infarction and coronary heart disease beyond conventional risk factors.
Key Points
- The study aims to determine if extreme lipoprotein(a) levels and LPA risk genotypes can enhance prediction of myocardial infarction and coronary heart disease risk beyond standard factors.
- Followed 8,720 Danish individuals from 1991 to 1994 until 2011 without loss to follow-up.
- Analyzed events of myocardial infarction and coronary heart disease using predefined extreme lipoprotein(a) levels and LPA genotypes.
- Calculated net reclassification indices to assess risk prediction improvements.
- For individuals with lipoprotein(a) levels ≥80th percentile, 23% of MI events and 12% of CHD events were correctly reclassified.
- Addition of lipoprotein(a) levels yielded net reclassification indices of +16% for MI and +3% for CHD.
- Increased risk prediction accuracy was observed for KIV-2 and SNPs rs3798220 and rs10455872.
Study Design
Type
Cohort (n=8,720)
Structured PICO
Does the addition of extreme lipoprotein(a) levels or LPA risk genotypes improve MI and CHD risk prediction beyond conventional risk factors in a general population?
P
Population
8,720 Danish participants in a general population study followed from 1991-1994 through 2011 to assess myocardial infarction and coronary heart disease risk prediction.
E
Exposure
Risk prediction including extreme lipoprotein(a) levels (≥80th percentile, ≥47 mg/dl) and/or corresponding LPA risk genotypes (KIV-2 repeat polymorphism, rs3798220, and rs10455872)
C
Comparator
Conventional risk prediction models
O
Outcome
Net reclassification indices for absolute 10-year myocardial infarction (MI) and coronary heart disease (CHD) riskhard clinical
Main Result
Effect estimate: NRI +16% (95% CI 8% to 24%)
Extreme lipoprotein(a) levels and corresponding LPA risk genotypes significantly improve risk prediction and reclassification for myocardial infarction and coronary heart disease beyond conventional risk factors.
Cite This Study
Kamstrup et al. (2013) conducted a cohort in General population (n=8,720). Extreme lipoprotein(a) levels (≥80th percentile) and/or LPA risk genotypes vs. Levels <80th percentile and non-risk genotypes was evaluated on Net reclassification index for absolute 10-year myocardial infarction risk (NRI +16%, 95% CI 8% to 24%). Addition of extreme lipoprotein(a) levels (≥80th percentile) improved risk prediction, yielding a net reclassification index of +16% (95% CI 8% to 24%) for myocardial infarction.