Association of lipoprotein(a) with cardiovascular outcomes and breast arterial calcification in postmenopausal women

This study examined the association of lipoprotein(a) [Lp(a)] with breast arterial calcification (BAC) and incident cardiovascular disease (CVD) in postmenopausal women. We analyzed data from 2,799 women in the MINERVA cohort (ages 60–79 years; 34% non-white) free of CVD at baseline and with available biomarkers. Associations of Lp(a) with BAC and CVD (including coronary heart disease (CHD; n = 65), ischemic stroke ( n = 47), atherosclerotic cardiovascular disease (ASCVD = CAD, ischemic stroke, or CHD death; n = 118), heart failure ( n = 45) and atrial fibrillation/flutter ( n = 164) were assessed using multivariate logistic and Cox regression. Overall, 66% had normal (< 30 mg/dL), 11% moderate (30–50 mg/dL) and 23% high (> 50 mg/dL) Lp(a) levels. Lp(a) varied by race/ethnicity (highest in African Americans and lowest in Asian/Pacific Islanders) and was positively correlated with apolipoprotein B and the social deprivation index. No association was observed between Lp(a) and BAC presence or gradation. After a mean follow-up of 11.2 (SD = 2.0) years, multivariate analyses revealed that each 1-SD increment in Lp(a) was associated with higher risk of CHD (HR = 1.45; 95% CI, 1.12–1.87), ischemic stroke (HR = 1.51; 95% CI, 1.11–2.06), and ASCVD (HR = 1.46; 95% CI, 1.20–1.77), but not with heart failure or atrial fibrillation/flutter. The ASCVD association was strongest among African American and not statistically significant in Asian/Pacific Islander women. Adding Lp(a) to PREVENT improved risk reclassification (bias-corrected categorical NRI = 0.10 for the 3 to < 5% group). Lp(a) is an ASCVD risk enhancer, supporting its role in primary prevention among postmenopausal women.