AIMS To validate the reported increased atherosclerotic cardiovascular disease (ASCVD) risk associated with very high lipoprotein(a) [Lp(a)] and to investigate the impact of routine Lp(a) assessment on risk reclassification. METHODS AND RESULTS We performed a cross-sectional case-control study in the Amsterdam UMC, a tertiary hospital in The Netherlands. All patients in whom a lipid blood test was ordered between October 2018 and October 2019 were included. Individuals with Lp(a) >99th percentile were age and sex matched to individuals with Lp(a) ≤20th percentile. We computed odds ratios (ORs) for myocardial infarction (MI) and ASCVD using multivariable logistic regression adjusted for age, sex, and systolic blood pressure. Furthermore, we assessed the additive value of Lp(a) to established ASCVD risk algorithms. Lipoprotein(a) levels were determined in 12 437 individuals, out of whom 119 cases [Lp(a) >99th percentile; >387.8 nmol/L] and 119 matched controls [Lp(a) ≤20th percentile; ≤7 nmol/L] were included. Mean age was 58 ± 15 years, 56.7% were female, and 30.7% had a history of ASCVD. Individuals with Lp(a) levels >99th percentile had an OR of 2.64 for ASCVD [95% confidence interval (CI) 1.45-4.89] and 3.39 for MI (95% CI 1.56-7.94). Addition of Lp(a) to ASCVD risk algorithms led to 31% and 63% being reclassified into a higher risk category for Systematic Coronary Risk Evaluation (SCORE) and Second Manifestations of ARTerial disease (SMART), respectively. CONCLUSION The prevalence of ASCVD is nearly three-fold higher in adults with Lp(a) >99th percentile compared with matched subjects with Lp(a) ≤20th percentile. In individuals with very high Lp(a), addition of Lp(a) resulted in one-third of patients being reclassified in primary prevention, and over half being reclassified in secondary prevention.

中文翻译：

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发现非常高的脂蛋白（a）：需要进行常规评估。

目的 验证报告的与极高脂蛋白 (a) [Lp(a)] 相关的动脉粥样硬化性心血管疾病 (ASCVD) 风险增加，并调查常规 Lp(a) 评估对风险重新分类的影响。方法和结果 我们在荷兰三级医院阿姆斯特丹 UMC 进行了一项横断面病例对照研究。包括在 2018 年 10 月至 2019 年 10 月期间接受血脂检测的所有患者。Lp(a) > 99% 的个体与 Lp(a) ≤ 20% 的个体年龄和性别相匹配。我们使用根据年龄、性别和收缩压调整的多变量逻辑回归计算心肌梗死 (MI) 和 ASCVD 的比值比 (OR)。此外，我们评估了 Lp(a) 对已建立的 ASCVD 风险算法的附加值。测定了 12437 人的脂蛋白 (a) 水平，其中 119 例 [Lp(a) > 第 99 个百分位数；>387.8 nmol/L] 和 119 个匹配对照 [Lp(a) ≤ 20%；≤7 nmol / L]被包括在内。平均年龄为 58 ± 15 岁，56.7% 为女性，30.7% 有 ASCVD 病史。Lp(a) 水平 > 第 99 个百分位数的个体对 ASCVD 的 OR 为 2.64 [95% 置信区间 (CI) 1.45-4.89]，对 MI 的 OR 为 3.39 (95% CI 1.56-7.94)。将 Lp(a) 添加到 ASCVD 风险算法导致 31% 和 63% 分别被重新分类为系统冠状动脉风险评估 (SCORE) 和动脉疾病第二表现 (SMART) 的更高风险类别。结论 与 Lp(a) ≤ 20% 的匹配受试者相比，Lp(a) > 99% 的成年人的 ASCVD 患病率高近三倍。