Abstract
Background and aimsLipoprotein(a) (Lp[a]) is a strong genetic risk factor for cardiovascular disease (CVD). The American Heart Association has prioritised seven cardiovascular health metrics to reduce the burden of CVD: body mass index, healthy diet, physical activity, smoking status, blood pressure, diabetes and cholesterol levels (together also known as ideal cardiovascular health). Our objective was to determine if individuals with high Lp(a) levels could derive cardiovascular benefits if characterized by ideal cardiovascular health. MethodsA total of 14,051 participants of the EPIC-Norfolk study were stratified according to the cardiovascular health score (based on the number of health metrics with an ideal, intermediate or poor status). Of them, 1732 had a CVD event during a mean follow-up of 11.5 years. Cox proportional hazards models were used to describe the association between the cardiovascular health score and Lp(a) level or genotype (as estimated by the rs10455872 variant) with the risk of CVD. ResultsWe observed little or no differences in serum Lp(a) levels across the seven cardiovascular health metric categories. Among participants with high serum Lp(a) levels ≥50 mg/dl), those in the highest (i.e. healthiest) cardiovascular health score category (10–14) had an adjusted hazard ratio for cardiovascular disease of 0.33 (95% CI = 0.17–0.63, p = 0.001) compared to participants in the lowest (i.e. unhealthiest) cardiovascular health score category(0–4). Similar results were obtained when we replaced Lp(a) with rs10455872. ConclusionsAlthough Lp(a) levels are only slightly influenced by cardiovascular health metrics, an ideal cardiovascular health could substantially reduce CVD risk associated with high Lp(a) levels or genotype.
Highlights
Lipoprotein(a) [Lp(a]) consists of a cholesterol rich lipoprotein particle analogous to low-density lipoprotein (LDL), whereN
Our results show that patients with ideal cardiovascular health and low Lp(a) levels are those with the lowest CVD event rate
Our results show that patients with ideal cardiovascular health who did not have the Lp(a)-raising allele are those with the lowest CVD event rate
Summary
Lipoprotein(a) [Lp(a]) consists of a cholesterol rich lipoprotein particle analogous to low-density lipoprotein (LDL), whereN. In 2010, a European Atherosclerosis Society Consensus Panel recommended that Lp(a) levels should be measured in individuals with premature CVD (or with a family history of premature CVD), familial hypercholesterolemia, recurrent CVD despite statin treatment or intermediate cardiovascular risk [1]. Even in these populations, Lp(a) is currently not routinely measured. Conclusions: Lp(a) levels are only slightly influenced by cardiovascular health metrics, an ideal cardiovascular health could substantially reduce CVD risk associated with high Lp(a) levels or genotype
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