Prognostic role of lipoprotein(a) in atherosclerotic cardiovascular disease risk from a perspective on current risk stratification

Abstract Lipoprotein(a) [Lp(a)] is an emerging predictor for atherosclerotic cardiovascular disease (ASCVD) but the association from a perspective on current risk stratification was unknown. A cohort of 9944 Chinese patients with ASCVD was recruited and refined into very‐high‐risk (VHR) and non‐VHR subgroups according to current guideline. Lp(a) plasma levels were divided by its concentration (<30, 30–50, 50–75, and ≥75 mg/dL) and percentile zones (<25th, 25–50th, 50–75th, 75–90th, ≥90th). Cardiovascular events (CVEs) occurred during an average of 38.5 months’ follow‐up were recorded. We found that Lp(a) was increased with risk stratification of ASCVD increasing. Prevalence of CVEs had a significantly increasing trend with gradients of Lp(a) elevation in VHR but not in non‐VHR subgroup. The adjusted HRs (95%CIs) for CVEs were 1.75(1.25–2.46) in the highest group of Lp(a) ≥75 mg/dL compared with the group of Lp(a) <30 mg/dL as the reference in overall patients, 2.18(1.32–3.58) in VHR subgroup and 1.43(0.93–2.18) in non‐VHR subgroup, respectively. The adjusted HRs (95%CIs) at the highest grade of Lp(a) levels (≥90th) were 1.72(1.19–2.50) in overall population, 2.83(1.53–5.24) in VHR subgroup and 1.38(0.86–2.12) in non‐VHR subgroup, respectively. These findings suggested that Lp(a) might contribute more to CVEs risk in VHR subgroup of ASCVD.