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Impact of Lipoprotein(a) Levels on Cardiovascular Risk Estimation

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A new cardiovascular risk (CVR) calculator that incorporates Lipoprotein(a) [Lp(a)] levels has recently been designed.


To estimate CVR using the new score and to identify the reduction in low-density lipoprotein cholesterol (LDL-C) or systolic blood pressure (SBP) necessary to balance the risk attributable to Lp(a).


CVR throughout life and at 10 years was estimated with the new score in patients in primary prevention, both considering and not considering the value of Lp(a). When the estimated risk considering Lp(a) levels exceeded the baseline risk, the reduction in LDL-C levels or SBP necessary to balance the risk attributable to Lp(a) was calculated.


In total, 671 patients (mean age 54.2 years, 47.2% women) were included. Globally, 22.7% of the population had high Lp(a) values (> 50 mg/dL or > 125 nmol/L). When calculating CVR throughout life and considering the Lp(a) value, the global risk increased in 66.7% of cases (median 19.3%). Similar results were observed when we assessed the 10-year risk. The risk associated with Lp(a) could be completely compensated by decreasing LDL-C (average 21 mg/dL) or SBP (average 6.3 mmHg) in 79.2% and 74.7% of cases, respectively.


When calculating the CVR with the new score, two-thirds and one-third of the population were bidirectionally recategorized as ‘up’ or ‘down,’ respectively. The decrease in LDL-C or SBP mitigated the increased risk caused by Lp(a) levels across a substantial proportion of patients.

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  1. Jawi MM, Frohlich J, Chan SY. Lipoprotein(a) the insurgent: a new insight into the structure, function, metabolism, pathogenicity, and medications affecting lipoprotein(a) molecule. J Lipids. 2020;2020:3491764.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Bhatia HS, Wilkinson MJ. Lipoprotein(a): evidence for role as a causal risk factor in cardiovascular disease and emerging therapies. J Clin Med. 2022;11:6040.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Tsimikas S. A test in context: lipoprotein(a): diagnosis, prognosis, controversies, and emerging therapies. J Am Coll Cardiol. 2017;69:692–711.

    Article  CAS  PubMed  Google Scholar 

  4. Mach F, Baigent C, Catapano A, Koskinas KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA, Graham IM, Halliday A, Landmesser U, Mihaylova B, Pedersen TR, Riccardi G, Richter DJ, Sabatine MS, Taskinen MR, Tokgozoglu L, Wiklund O. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41:111–88.

    Article  PubMed  Google Scholar 

  5. Wilson DP, Jacobson TA, Jones PH, Koschinsky ML, McNeal CJ, Nordestgaard BG, Orringer C. Use of Lipoprotein(a) in clinical practice: a biomarker whose time has come. A scientific statement from the National Lipid Association. J Clin Lipidol. 2019;13:374–92.

    Article  PubMed  Google Scholar 

  6. Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97:1837–47.

    Article  CAS  PubMed  Google Scholar 

  7. Assmann G, Cullen P, Schulte H. Simple scoring scheme for calculating the risk of acute coronary events based on the 10-year follow-up of the prospective cardiovascular Münster (PROCAM) study. Circulation. 2002;105:310–5.

    Article  PubMed  Google Scholar 

  8. Conroy RM, Pyörälä K, Fitzgerald AP, Sans S, Menotti A, De Backer G, Ducimetière P, Jousilahti P, Keil U, Njølstad I, Oganov RG, Thomsen T, Tunstall-Pedoe H, Tverdal A, Wedel H, Whincup P, Wilhelmsen L, Graham IM. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 2003;24:987–1003.

    Article  CAS  PubMed  Google Scholar 

  9. Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, May M, Brindle P. Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study. BMJ. 2007;335:136.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, Goldberg R, Heidenreich PA, Hlatky MA, Jones DW, Lloyd-Jones D, Lopez-Pajares N, Ndumele CE, Orringer CE, Peralta CA, Saseen JJ, Smith SC Jr, Sperling L, Virani SS, Yeboah J. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart association task force on clinical practice guidelines. Circulation. 2019;139:e1082–143.

    Article  PubMed  Google Scholar 

  11. Kronenberg F, Mora S, Stroes ES, Ference BA, Arsenault BJ, Berglund L, Dweck MR, Koschinsky M, Lambert G, Mach F, McNeal CJ, Moriarty PM, Natarajan P, Nordestgaard BG, Parhofer KG, Virani SS, von Eckardstein A, Watts GF, Stock JK, Ray KK, Tokgözoğlu LS, Catapano AL. Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. Eur Heart J. 2022;43:3925–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Kronenberg F, Mora S, Stroes ESG, Ference BA, Arsenault BJ, Berglund L, Dweck MR, Koschinsky ML, Lambert G, Mach F, McNeal CJ, Moriarty PM, Natarajan P, Nordestgaard BG, Parhofer KG, Virani SS, von Eckardstein A, Watts GF, Stock JK, Ray KK, Tokgözoğlu LS, Catapano AL. Frequent questions and responses on the 2022 lipoprotein(a) consensus statement of the European Atherosclerosis Society. Atherosclerosis. 2023;374:107–20.

    Article  CAS  PubMed  Google Scholar 

  13. Lp(a) Clinical Guidance. Accessed 17 Apr 2024.

  14. Nordestgaard B, Chapman MJ, Ray K, Borén J, Andreotti F, Watts G, Ginsberg H, Amarenco P, Catapano A, Descamps OS, Fisher E, Kovanen PT, Kuivenhoven JA, Lesnik P, Masana L, Reiner Z, Taskinen MR, Tokgözoglu L, Tybjærg-Hansen A. Lipoprotein(a) as a cardiovascular risk factor: current status. Eur Heart J. 2010;31:2844–53.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Nordestgaard BG, Langsted A. Lipoprotein(a) as a cause of cardiovascular disease: insights from epidemiology, genetics, and biology. J Lipid Res. 2016;57:1953–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Paré G, Çaku A, McQueen M, Anand SS, Enas E, Clarke R, Boffa MB, Koschinsky M, Wang X, Yusuf S. Lipoprotein(a) levels and the risk of myocardial infarction among 7 ethnic groups. Circulation. 2019;139(12):1472–82.

    Article  CAS  PubMed  Google Scholar 

  17. Muzzio M, Motti JMB, Paz Sepulveda PB, Yee M-C, Cooke T, Santos MR, Ramallo V, Alfaro EL, Dipierri JE, Bailliet G, Bravi CM, Bustamante CD, Kenny EE. Population structure in Argentina. PLoS ONE. 2018;13:e0196325.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Willeit P, Kiechl S, Kronenberg F, Witztum JL, Santer P, Mayr M, Xu Q, Mayr A, Willeit J, Tsimikas S. Discrimination and net reclassification of cardiovascular risk with lipoprotein (a) prospective 15-year outcomes in the Bruneck study. J Am Coll Cardiol. 2014;64:851–60.

    Article  PubMed  Google Scholar 

  19. Ghavami M, Abdshah A, Esteghamati S, Hafezi-Nejad N, Nakhjavani M, Esteghamati A. Serum lipoprotein(a) and reclassification of coronary heart disease risk; application of prediction in a cross-sectional analysis of an ongoing Iranian cohort. BMC Public Health. 2023;23:2402.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Kamstrup PR, Tybjærg-Hansen A, Nordestgaard BG. Extreme lipoprotein(a) levels and improved cardiovascular risk prediction. J Am Coll Cardiol. 2013;61:1146–56.

    Article  CAS  PubMed  Google Scholar 

  21. Tschiderer L, Seekircher L, Willeit P, Peters SAE. Assessment of cardiovascular risk in women: progress so far and progress to come. Int J Womens Health. 2023;15:191–212.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Berman AN, Biery DW, Besser SA, Singh A, Shiyovich A, Weber BN, Huck DM, Divakaran S, Hainer J, Kaur G, Blaha MJ, Cannon CP, Plutzky J, Januzzi JL, Booth JN 3rd, López JAG, Kent ST, Nasir K, Di Carli MF, Bhatt DL, Blankstein R. Lipoprotein(a) and major adverse cardiovascular events in patients with or without baseline atherosclerotic cardiovascular disease. J Am Coll Cardiol. 2024;83:873–86.

    Article  CAS  PubMed  Google Scholar 

  23. Tsimikas S, Gordts PLSM, Nora C, Yeang C, Witztum JL. Statin therapy increases lipoprotein(a) levels. Eur Heart J. 2020;41:2275–84.

    Article  CAS  PubMed  Google Scholar 

  24. Feng T, Li Y, Xue X, Yang W, Li Q, Huang Y, Zhu T, Wang J, Xu L, Li X, Gao J, Sun S, Zhu B, Zhang S, Cao B, Xuan J, Zhao Z, Qian B. Association of statin use and increase in lipoprotein(a): a real-world database research. Eur J Med Res. 2023;28:212.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Yu Z, Hu L, Sun C, Wang Z, Zhang X, Wu M, Liu L. Effect of different types and dosages of proprotein convertase subtilisin/kexin type 9 inhibitors on lipoprotein(a) levels: a network meta-analysis. J Cardiovasc Pharmacol. 2023;81:445–53.

    Article  CAS  PubMed  Google Scholar 

  26. O’Donoghue ML, Fazio S, Giugliano RP, Stroes ESG, Kanevsky E, Gouni-Berthold I, Im K, Pineda AL, Wasserman SM, Češka R, Ezhov MV, Jukema JW, Jensen HK, Tokgözoğlu SL, Mach F, Huber K, Sever PS, Keech AC, Pedersen TR, Sabatine MS. Lipoprotein(a), PCSK9 inhibition, and cardiovascular risk. Circulation. 2019;139:1483–92.

    Article  CAS  PubMed  Google Scholar 

  27. Fragasso G, Margonato A, Spoladore R, Lopaschuk GD. Metabolic effects of cardiovascular drugs. Trends Cardiovasc Med. 2019;29:176–87.

    Article  CAS  PubMed  Google Scholar 

  28. Marques-Vidal P, Montaye M, Haas B, Bingham A, Evans A, Juhan-Vague I, Ferrières J, Luc G, Amouyel P, Arveiler D, McMaster D, Ruidavets JB, Bard JM, Scarabin PY, Ducimetière P. Association of hypertensive status and its drug treatment with lipid and haemostatic factors in middle-aged men: the PRIME study. J Hum Hypertens. 2000;14:511–8.

    Article  CAS  PubMed  Google Scholar 

  29. Sukkari MH, Al-Bast B, Al Tamimi R, Giesing W, Siddique M. Is there a benefit of aspirin therapy for primary prevention to reduce the risk of atherosclerotic cardiovascular disease in patients with elevated Lipoprotein (a)—a review of the evidence. Am J Prev Cardiol. 2023;15: 100579.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Bhatia HS, Trainor P, Carlisle S, Tsai MY, Criqui MH, DeFilippis A, Tsimikas S. Aspirin and cardiovascular risk in individuals with elevated lipoprotein(a): the multi-ethnic study of atherosclerosis. J Am Heart Assoc. 2024;13: e033562.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Maloberti A, Fabbri S, Colombo V, Gualini E, Monticelli M, Daus F, Busti A, Galasso M, De Censi L, Algeri M, Merlini PA, Giannattasio C. Lipoprotein(a): cardiovascular disease, aortic stenosis and new therapeutic option. Int J Mol Sci. 2022;24(1):170.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Correspondence to Walter Masson.

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The authors did not receive support from any organization for the submitted work.

Conflicts of interest

The authors have no relevant financial or non-financial interests to disclose.

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The data underlying this article are available in the article.

Author contributions

WM and DS participated in the conception and design of the research. WM, GW, MH, LB, DS, ALC and PC participated in the data collection. WM and DS performed the statistical analysis. WM, ALC, PC and DS drafted the manuscript. All authors performed a critical review of the final document. All authors have read and agreed to the published version of the manuscript.

Ethical considerations

The study was conducted in accordance with the recommendations for medical research. Ethical approval was waived by the local Ethics Committee of the Italian Hospital of Buenos Aires (approval number 6951) in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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Masson, W., Waisman, G., Corral, P. et al. Impact of Lipoprotein(a) Levels on Cardiovascular Risk Estimation. High Blood Press Cardiovasc Prev (2024).

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