Having high Lp(a) is equivalent to having diabetes and smoking

This was a retrospective contemporary cohort study of 6238 patients who did not have prior ASCVD, that were evaluated the risk of first AMI (heart attack) associated with high Lp(a) relative to Standard Modifiable Risk Factors (SMuRFs) over 8.8 years.

SMuRFs here are not the little blue guys from the 60s.

Instead they are an acronym for Standard Modifiable Risk Factors defined in this study as diabetes, hypertension, smoking, and dyslipidemia. These are disease states that have a negative effect on your heart health that you can do something about.

High Lp(a) was defined as being over the 90th percentile.

Low Lp(a) was defined as being under the 50th percentile.

Importantly, all participants started the study with no diagnosis of ASCVD. This is key if we are looking to use the Lp(a) assay in primary prevention.

A reminder on hazard ratios (HR) you subtract 1 from the HR and it gives you the change in risk for developing the outcome. For example, having 2 SMuRFs has an HR or 2.97, meaning that having 2 SMuRFs increases your risk of having a heart attack over the next 8.8 years (duration of the study) by 197%. 

The math spelled out: (2.97 - 1) *100% = 197% increase in risk

That means having a high Lp(a) increases your risk of a heart attack over the next 8.8 years by 188%. Not the category I want to be in.

Can we reduce Lp(a)? Lp(a) levels are largely genetically determined. At this time we cannot make a meaningful change in the Lp(a) through pharmacology, diet, or exercise (at least not enough to really move the needle on risk). 

So what is the point? This is one of those things where knowing if you have it can light the fire under your ass to really take care of the other things that you can control. Don't want a heart attack? Do you have a 188% increased risk of a heart attack? Then stop smoking and get your diabetes under control so that your heart has less doing it wrong.

Take home: Having high Lp(a) is as bad for your heart as having 2 of the following 4 conditions (diabetes, hypertension, smoking, and dyslipidemia)

Link to Article

Shiyovich A, Berman AN, Besser SA, Biery DW, Kaur G, Divakaran S, Singh A, Huck DM, Weber B, Plutzky J, Di Carli MF, Nasir K, Cannon C, Januzzi JL, Bhatt DL, Blankstein R. Association of Lipoprotein (a) and Standard Modifiable Cardiovascular Risk Factors With Incident Myocardial Infarction: The Mass General Brigham Lp(a) Registry. J Am Heart Assoc. 2024 May 21;13(10):e034493. doi: 10.1161/JAHA.123.034493. Epub 2024 May 18. PMID: 38761082; PMCID: PMC11179826.