Lp(a) and LDL-c are independent and Additive Predictors of ASCVD Risk
Lp(a) and LDL-c are independent and Additive Predictors of ASCVD Risk.
📅 Highlighted by AHA: March 11, 2025
📄 Source: Circulation
📑 Study: Bhatia HS, Wandel S, Willeit P, et. A Participant-Level Meta-Analysis. Circulation. 2025.
Key Findings:
• Independent Risk Factors: Baseline LDL-c and Lp(a) levels were independently associated with increased ASCVD risk.
• Additive Effect: Patients with high levels of both LDL-c and Lp(a) had the highest ASCVD risk.
• Statin-Treated Patients:
• Elevated Lp(a) levels remained associated with ASCVD risk regardless of LDL-c reduction.
• LDL-c levels alone were not significantly associated with ASCVD risk in statin-treated patients.
• Meta-Analysis Details:
• Included six randomized controlled statin trials (4D, 4S, CARDS, JUPITER, LIPID, MIRACL).
• Data from 27,658 participants with a median follow-up of 2.8 years.
• Baseline Lp(a) vs. Achieved LDL-c:
• ASCVD risk was highest in patients with Lp(a) >50 mg/dL and LDL-c in the highest quartile (>140.8 mg/dL).
• Even in patients achieving the lowest LDL-c levels (<77.3 mg/dL), those with Lp(a) >50 mg/dL had a higher ASCVD risk.
• Clinical Implication:
• Lowering LDL-c alone does not eliminate Lp(a)-related cardiovascular risk.
• The findings highlight the need for Lp(a) testing and its integration into cardiovascular risk assessment.