Lipoprotein (a), metabolic syndrome and coronary calcium score in a large occupational cohort

Background and aims: Whether lipoprotein (a) [Lp(a)] concentration is associated with metabolic syndrome (MetS) and pre-clinical atherosclerosis in different ethnic groups is uncertain. The association between Lp(a), MetS and a measure of pre-clinical atherosclerosis was studied in a large Asian cohort. Methods and results: Data were analyzed from a South Korean occupational cohort who underwent a cardiac computed tomography (CT) estimation of CAC score and measurements of cardiovascular risk factors (n=14,583 people). The key exposure was an Lp(a) concentration in the top quartile (>38.64mg/dL)) with a CAC score >0 as the outcome variable and measure of pre-clinical atherosclerosis. Logistic regression was used to describe the associations. 1462 participants had a CAC score >0. In the lowest Lp(a) quartile (<11.29mg/dL), 25.8% had MetS, compared with 16.1% in the highest Lp(a) quartile (>38.64mg/dL (p<0.001). MetS, and component features, were inversely related to Lp(a) concentration (all p<0.0001). In the highest Lp(a) quartile group, there was an association between Lp(a) and CAC score >0 in men (OR 1.21[1.05, 1.40], p=0.008), and women (OR 1.62[1.03, 2.55], p=0.038), after adjustment for age, sex, lipid lowering therapy, and multiple cardiovascular risk factors. There was no evidence of an interaction between highest quartile Lp(a) and either high LDLc (>147mg/dL) (p=0.99), or MetS (p=0.84) on the association with CAC score >0. Conclusion: Lp(a) levels are inversely related to MetS and its components. There was a robust association between Lp(a) concentration >38.6mg/dL and marker of early atherosclerosis in both men and women, regardless of LDLc, level MetS or other cardiovascular risk factors.