Lipoprotein(a) levels in a global population with established atherosclerotic cardiovascular disease

Steven E. Nissen, Kathy Wolski, Leslie Cho, Stephen J. Nicholls, John Kastelein, Eran Leitersdorf, Ulf Landmesser, Michael Blaha, A. Michael Lincoff, Ryuichi Morishita, Sotirios Tsimikas, Junhao Liu, Brian Manning, Plamen Kozlovski, Anastasia Lesogor, Tom Thuren, Taro Shibasaki, Florin Matei, F. bio Serra Silveira, Andreas MeunchAysha Bada, Vinod Vijan, Niels Eske Bruun, Borge G. Nordestgaard

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3 Citations (Scopus)


Objective Lipoprotein(a) (Lp(a)) is an important genetically determined risk factor for atherosclerotic vascular disease (ASCVD). With the development of Lp(a)-lowering therapies, this study sought to characterise patterns of Lp(a) levels in a global ASCVD population and identify racial, ethnic, regional and gender differences. Methods A multicentre cross-sectional epidemiological study to estimate the prevalence of elevated Lp(a) in patients with a history of myocardial infarction, ischaemic stroke or peripheral artery disease conducted at 949 sites in 48 countries in North America, Europe, Asia, South America, South Africa and Australia between April 2019 and July 2021. Low-density lipoprotein cholesterol (LDL-C) and Lp(a) levels were measured either as mass (mg/dL) or molar concentration (nmol/L). Results Of 48 135 enrolled patients, 13.9% had prior measurements of Lp(a). Mean age was 62.6 (SD 10.1) years and 25.9% were female. Median Lp(a) was 18.0 mg/dL (IQR 7.9-57.1) or 42.0 nmol/L (IQR 15.0-155.4). Median LDL-C was 77 mg/dL (IQR 58.4-101.0). Lp(a) in women was higher, 22.8 (IQR 9.0-73.0) mg/dL, than in men, 17.0 (IQR 7.1-52.2) mg/dL, p<0.001. Black patients had Lp(a) levels approximately threefold higher than white, Hispanic or Asian patients. Younger patients also had higher levels. 27.9% of patients had Lp(a) levels >50 mg/dL, 20.7% had levels >70 mg/dL, 12.9% were >90 mg/dL and 26.0% of patients exceeded 150 nmol/L. Conclusions Globally, Lp(a) is measured in a small minority of patients with ASCVD and is highest in black, younger and female patients. More than 25% of patients had levels exceeding the established threshold for increased cardiovascular risk, approximately 50 mg/dL or 125 nmol/L.
Original languageEnglish
Article number002060
Issue number2
Publication statusPublished - 17 Oct 2022


  • atherosclerosis
  • global burden of disease
  • hyperlipidemias

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