Elevated plasma levels of lipoprotein(a) and family history of coronary heart disease (CHD) were found to be associated — both independently and additively — with a risk for cardiovascular disease in asymptomatic individuals, according to a study published in the Journal of the American College of Cardiology.

Plasma lipoprotein(a) levels and family history of CHD were examined in participants of the Atherosclerosis Risk In Communities (ARIC) study (n=12,149) and the Dallas Heart Study (DHS; n=2756). In the ARIC cohort, mean age was 53.9±5.7 years, 56.1% of participants were women, 76.8% were white, 44.4% had a family history of CHD, and 9.8% had premature family history of CHD. In the DHS cohort, mean age was 43.6±9.9 years, 56.8% of participants were women, 32.1% were white, 31.1% had a family history of CHD, and 10.1% had premature family history of CHD.

In the ARIC cohort, 3114 atherosclerotic cardiovascular disease (ASCVD) events were observed during the 21 years of follow-up. Family history of CHD and elevated lipoprotein(a) levels were independently associated with ASCVD (hazard ratio [HR], 1.17; 95% CI, 1.09-1.26; and HR, 1.25; 95% CI, 1.12-1.40, respectively). Family history of CHD did not affect the association between elevated lipoprotein(a) levels with CHD and ASCVD (P =.753 and P =848, respectively).

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Participants who had elevated lipoprotein(a) levels or family history of CHD vs those with neither of those factors had a higher risk for ASCVD, and participants with both those factors had the highest risk (HR, 1.43; 95% CI, 1.27-1.62). Similar findings were observed for CHD risk in the ARIC cohort, in analyses stratified by premature family history, and in the independent DHS cohort.

“These results suggest that both lipoprotein(a) and family history are at least additive, and in some cases multiplicative, for cardiovascular risk assessment,” noted the investigators. “Elevated plasma lipoprotein(a) level and family history of CHD (either premature or at any age) have an independent and additive joint association with long-term cardiovascular risk.”

The investigators noted that the definition of family history of CHD was cohort-specific, the data were obtained using self-report at enrollment, and the impact of statin and cardiovascular risk reduction therapy use was not evaluated in this study.

“Our findings are highly relevant in the context of the current landscape of primary ASCVD prevention,” the study authors commented.

Disclosures: Some of the study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.


Mehta A, Virani SS, Ayers CR, et al. Lipoprotein(a) and family history predict cardiovascular disease risk. J Am Coll Cardiol. 2020;76:781-793.