Association of lipoprotein(a) and coronary artery calcium with atherosclerotic cardiovascular disease

BACKGROUND: A combined evaluation of the associations of lipoprotein(a) (LP[a]) and coronary artery calcium score (CACS) with atherosclerotic cardiovascular disease (ASCVD) has not been conducted in the Asian population. OBJECTIVE: We explored whether elevated LP(a) levels and CACS are independently and jointly associated with ASCVD. METHODS: This cross-sectional study included 44,354 participants (mean age 40.6 years, 72.8% male) from the Kangbuk Samsung Health Study, conducted between March 2010 and December 2019, who were tested for LP(a) and CACS. High LP(a) was defined as LP(a) ≥120 nmol/L, and CACS categories were divided as CACS = 0 vs CACS > 0. ASCVD was identified as physician-diagnosed or -treated angina pectoris, myocardial infarction, or ischemic stroke. RESULTS: The prevalence of high LP(a), CACS >0, and ASCVD was 11.9%, 15.7%, and 1.1%, respectively. Multivariable regression analyses indicated that high LP(a) and CACS >0 were independently associated with prevalent ASCVD (odds ratio [95% CI], 1.36 [1.02, 1.81] and 1.79 [1.40, 2.30], respectively). Compared with individuals with low LP(a)/CACS = 0, those with high LP(a)/CACS > 0 had the highest odds ratio for ASCVD (2.40 [1.58, 3.63]), as did those with low LP(a)/CACS > 0 (1.79 [1.38, 2.33]). However, high LP(a)/CACS = 0 did not significantly increase the odds ratio for ASCVD (1.36 [0.90, 2.05]). CONCLUSION: High LP(a) levels and the presence of CAC are independently associated with ASCVD. Given that both markers were additively associated with ASCVD when elevated, more aggressive management to reduce cardiovascular risk may be warranted. Longitudinal studies are necessary to clarify the combined causal relationship between these 2 markers and cardiovascular events in the Asian population.