Lipoprotein(a) and secondary prevention of atherothrombotic events: A critical appraisal

Michael B Boffa; Saverio Stranges; Neil Klar; Patrick M Moriarty; Gerald F Watts; Marlys L Koschinsky

doi:10.1016/j.jacl.2018.08.012

Lipoprotein(a) and secondary prevention of atherothrombotic events: A critical appraisal

J Clin Lipidol. 2018 Nov-Dec;12(6):1358-1366. doi: 10.1016/j.jacl.2018.08.012. Epub 2018 Sep 11.

Authors

Michael B Boffa¹, Saverio Stranges², Neil Klar³, Patrick M Moriarty⁴, Gerald F Watts⁵, Marlys L Koschinsky⁶

Affiliations

¹ Department of Biochemistry, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada.
² Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada; Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada; Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg.
³ Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada.
⁴ Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
⁵ School of Medicine, University of Western Australia, Perth, Australia; Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, Perth, Australia.
⁶ Robarts Research Institute, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada. Electronic address: mlk@robarts.ca.

PMID: 30316749
DOI: 10.1016/j.jacl.2018.08.012

Abstract

Elevated plasma concentrations of lipoprotein(a) [Lp(a)] are an independent, and possibly causal, risk factor for atherothrombotic diseases including coronary heart disease. The principal evidence base for this comes from large population studies focusing on first atherothrombotic events. However, inconsistent findings have been reported from studies investigating the impact of elevated Lp(a) on atherothrombotic events in subjects with preexisting cardiovascular disease. This question is very important because the secondary prevention population is recommended for Lp(a) screening by some guidelines and could be an important target group for Lp(a)-lowering therapies that are currently on the horizon. In this review, we survey the secondary prevention literature as it relates to Lp(a) and identify some possible confounding factors that may underlie the inconsistent findings, such as index event bias.

Keywords: Atherothrombotic disease; Clinical studies; Confounding; Coronary heart disease; Epidemiology; Risk factors.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Atherosclerosis / complications*
Humans
Lipoprotein(a) / blood*
Secondary Prevention / methods*
Thrombosis / blood*
Thrombosis / complications
Thrombosis / prevention & control*

Substances

Lipoprotein(a)

Grants and funding

MOP-126076/CIHR/Canada