Lipoprotein(a) and cardiovascular disease in individuals aged 70-100 years
J Jeevanathan, P E Thomas, P R Kamstrup, B G NordestgaardAbstract
Background
High lipoprotein(a) is considered a causal risk factor for atherosclerotic cardiovascular diseases; however, whether lipoprotein(a) is also a strong risk factor in individuals aged 70-100 is unclear. We tested the hypothesis that individuals aged 70-100 with high lipoprotein(a) have the highest absolute risk of atherosclerotic cardiovascular disease.
Methods
We included 59,325 women and 48,597 men aged 20-100 years from the Copenhagen General Population Study, of which 20,723 were aged 70-100. Age- and sex-stratified incidence rates and hazard ratios for atherosclerotic cardiovascular disease were estimated.
Results
During a median follow-up of 12.5 years (maximum 19.1), 9,091 individuals were diagnosed with atherosclerotic cardiovascular disease. Atherosclerotic cardiovascular disease incidence increase per 50 mg/dL (105 nmol/L) higher lipoprotein(a) were 0.3 (95% confidence interval 0.2-0.4) for age 20-49, 0.8(0.6-0.9) for age 50-59, 1.5(1.2-1.7) for age 60-69, 2.7(2.2-3.2) for age 70-79, and 4.5(3.7-5.4) for age 80-100. For lipoprotein(a) of 70-89 mg/dL(148-190 nmol/L) such incidence increases were 2.7 for age 20-49, 7.1 for age 50-59, 13.3 for age 60-69, 24.4 for age 70-79, and 40.9 for age 80-100. Corresponding values for lipoprotein(a) of 90-426 mg/dL(191-924 nmol/L) were 3.2, 8.3, 15.6, 28.7, and 48, respectively. The above results were similar in women and men, but with the highest incidence increases in men. Hazard ratios per 50 mg/dL higher lipoprotein(a) were similar across all age groups and sexes ranging from 1.12-1.18 (p for interaction: by age=0.48; by sex=0.74).
Conclusions
In a contemporary primary prevention cohort, individuals aged 70-100 with high lipoprotein(a) had the highest absolute risk of atherosclerotic cardiovascular disease.Figure 1Figure 2