Increased lipoprotein(a) multiplies coronary heart disease risk in patients with familial hypercholesterolemia

Abstract

Abstract Background Familial hypercholesterolemia (FH) and elevated lipoprotein(a) (Lp[a]) are individually associated with increased coronary heart disease (CHD) risk. Purpose To determine the independent and joint associations of FH and Lp(a) with CHD. Methods This was a cross-sectional study including adult patients with dyslipidemia followed at our University General Hospital, Greece. FH diagnosis was based on the Dutch Clinic Lipid Network Criteria (score ≥5), while elevated Lp(a) levels were defined as >30 mg/dL. Independent and joint associations of FH and Lp(a) with CHD prevalence were determined using binary logistic regression models adjusted for traditional cardiovascular risk factors. Results Among 941 participants (49 years, 47% males, 54% with FH, 36% with increased Lp[a]), the prevalence of CHD was 7.7% (n=72). Compared with subjects without FH and non-elevated Lp(a) (n=296), those with either FH (adjusted OR: 3.21, 95% CI: 1.35–7.62, n=271) or elevated Lp(a) (adjusted OR: 1.89, 95% CI: 0.76–4.69, n=180) were at higher CHD risk. The patients with both FH and elevated Lp(a) had the highest CHD risk (adjusted OR: 7.31; 95% CI: 3.09–17.32, n=195). Among FH patients, increased Lp(a) doubled CHD risk (adjusted OR: 2.22, 95% CI: 1.02–4.83), whereas among patients with elevated Lp(a), FH was associated with a 5-fold increase in CHD risk (adjusted OR: 4.96, 95% CI: 1.83–13.43). Conclusions FH and elevated Lp(a) have independent and additive associations with CHD prevalence. This may have therapeutic implications regarding treatment intensity. Funding Acknowledgement Type of funding sources: None.