ArticleCirculation. Genomic and precision medicine2025
Lipoprotein(a) Atherosclerotic Cardiovascular Disease Risk Score Development and Prediction in Primary Prevention From Real-World Data.
Article in Circulation. Genomic and precision medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Apolipoprotein(a)-rich electronegative HDL accelerates vascular aging and atherosclerosis by inducing endothelial senescence.GeroScience · 2026Article
- Expert consensus on Lipoprotein(a) in the Gulf countries: Navigating cardiovascular risk and therapeutic advances.Atherosclerosis plus · 2026Article
- Lipoprotein(a) in Personalized Cardiovascular Prevention: Risk Stratification, Coronary Artery Calcium, and Emerging Lp(a)-Lowering Therapies.Journal of clinical medicine · 2026Review
- Review
- Impact of Lipoprotein(a) on Residual Cardiovascular Risk After an Acute Coronary Syndrome.Journal of clinical medicine · 2026Review
- Lipoprotein(a) and Cardiovascular Disease: From Genetic Risk Factor to Therapeutic Target.Cells · 2026Review
- Prognostic significance of bilateral carotid plaque asymmetry for major cardiovascular events in high-risk patients: a 3-year retrospective cohort study.The international journal of cardiovascular imaging · 2025Article
- Lipoprotein (a) in primary cardiovascular disease prevention is actionable today.American heart journal plus : cardiology research and practice · 2025Review
- Role of Lipoprotein(a) in Atherosclerotic Cardiovascular Disease in South Asian Individuals.Journal of the American Heart Association · 2025Review
- Lipoprotein(a) and Cardiovascular Risk in Asian Populations: A Comprehensive Review.Journal of lipid and atherosclerosis · 2025Review
- Many Journeys Originating at the Same Source to Arrive at Solutions to the Common Problem of High Lipoprotein(a).Circulation. Genomic and precision medicine · 2025Article
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Authors and funding
3 authors.
Funding
Abstract
backgroundLipoprotein(a) [Lp(a)] is a predictor of atherosclerotic cardiovascular disease (ASCVD); however, there are few algorithms incorporating Lp(a), especially from real-world settings. We developed an electronic health record (EHR)-based risk prediction algorithm including Lp(a).
methodsUtilizing a large EHR database, we categorized Lp(a) cut points at 25, 50, and 75 mg/dL and constructed 10-year ASCVD risk prediction models incorporating Lp(a), with external validation in a pooled cohort of 4 US prospective studies. Net reclassification improvement was determined among borderline-intermediate risk patients.
resultsWe included 5902 patients aged ≥18 years (mean age 48.7±16.7 years, 51.2% women, and 7.7% Black). Our EHR model included Lp(a), age, sex, Black race/ethnicity, systolic blood pressure, total and high-density lipoprotein cholesterol, diabetes, smoking, and hypertension medication. Over a mean follow-up of 6.8 years, ASCVD event rates (per 1000 person-years) ranged from 8.7 to 16.7 across Lp(a) groups. A 25 mg/dL increment in Lp(a) was associated with an adjusted hazard ratio of 1.23 (95% CI, 1.10-1.37) for composite ASCVD. Those with Lp(a) ≥75 mg/dL had an 88% higher risk of ASCVD (hazard ratio, 1.88 [95% CI, 1.30-2.70]) and more than double the risk of incident stroke (hazard ratio, 2.55 [95% CI, 1.54-4.23]). C-statistics for our EHR and EHR+Lp(a) models in our EHR training data set were 0.7475 and 0.7556, respectively, with external validation in our pooled cohort (n=21 864) of 0.7350 and 0.7368, respectively. Among those at borderline/intermediate risk, the net reclassification improvement was 21.3%.
conclusionsWe show the feasibility of developing an improved ASCVD risk prediction model incorporating Lp(a) based on a real-world adult clinic population. The inclusion of Lp(a) in ASCVD prediction models can reclassify risk in patients who may benefit from more intensified ASCVD prevention efforts.
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