Patients with high plasma levels of lipoprotein(a) have an increased risk for ischemic stroke, both observationally and causally from genetics, according to results published in the Journal of the American College of Cardiology.
The study included participants from the Copenhagen General Population Study (n=49,699) and participants from the Copenhagen City Heart Study (n=10,813) who had measurements of plasma lipoprotein(a), LPA kringle-IV type 2 number of repeats, and LPA rs10455872. The researchers used Danish national health registries to determine ischemic stroke, which was validated by medical doctors.
After adjusting for variables, the researchers found that participants with lipoprotein(a) levels >93 mg/dL (>199 nmol/L: 96th-100th percentile) had a hazard ratio of 1.60 for ischemic stroke (95% CI, 1.24-2.05) compared with participants whose lipoprotein(a) levels were <10 mg/dL (<18 nmol/L: 1st-50th percentile).
In an observational analysis, the researchers found that for 50 mg/dL (105 nmol/L) higher lipoprotein(a) level, the age- and sex- adjusted genetic causal risk ratio for ischemic stroke was 1.20 (95% CI, 1.13-1.28). The corresponding age- and sex-adjusted genetic causal risk ratio for kringle-IV type 2 number of repeats was 1.20 (95% CI, 1.02-1.43) and 1.27 (95% CI, 1.06-1.51) for rs10455872.
Participants who had the highest absolute 10-year risk for ischemic stroke (17%) were smokers >70 years of age with hypertension and lipoprotein(a) levels >93 mg/dL (>199 nmol/L: 96th-100th percentile).
“Randomized trials are needed to evaluate the efficacy of lipoprotein(a)-lowering for prevention of cardiovascular diseases, including ischemic stroke,” the researchers wrote.
Disclosure: Børge G. Nordestgaard, MD, DMSc, has served as a consultant and/or provided sponsored talks for Akcea, Amgen, Sanofi, Regeneron, and AstraZeneca.
Langsted A, Nordestgaard BG, Kamstrup PR. Elevated lipoprotein(a) and risk of ischemic stroke. J Am Coll Cardiol. 2019;74(1):54-66.