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REFLECTIONS
Dyslipidaemia
Dyslipidaemia Global Newsletter #9 2025

measurements. Elevated Lp(a) was defined as a level of 125 nmol/L or higher. The main outcomes measured were CHD, ASCVD,
HF, and total CVD, with participants categorised into low (<5%), borderline (5% to <7.5%), intermediate (7.5% to <20%), and high
(≥20%) risk categories. Analyses were conducted until March of 2025 and 10-year observed event rates were calculated. The
Dyslipidaemia
association between elevated Lp(a) and outcomes, and improvement in risk prediction with Lp(a) addition using continuous and
categorical net reclassification improvement (NRI) were also evaluated.

Ten-year ASCVD event rates stratified by the AHA PREVENT risk category

ASCVD, atherosclerotic cardiovascular disease; Lp(a), lipoprotein(a); MESA, Multi-Ethnic Study of Atherosclerosis; PREVENT, Predicting Risk of
Cardiovascular Disease Events; UKB, UK Biobank.
The study found that the observed 10-year ASCVD event rates fell within the bounds of predicted risk categories regardless of
Lp(a) level. Although participants with elevated Lp(a) had higher event rates than did those with non-elevated Lp(a) (HR, 1.30; 95%
CI, 1.22–1.38). Similar results were observed for CHD, HF, and total CVD. Adding elevated Lp(a) values to PREVENT somewhat
improved ASCVD risk prediction (category-free NRI, 0.058; 95% CI, 0.043–0.065; categorical NRI, 0.006, 95% CI, 0.004–0.011) with
the greatest improvement in borderline-risk. When Lp(a) was evaluated continuously, the greatest improvement in prediction was
among individuals at low-risk, whereas for CHD, the greatest improvement in prediction was among low- and high-risk individuals.

Association of elevated lipoprotein(a) and ASCVD risk by the AHA PREVENT risk category

ASCVD, atherosclerotic cardiovascular disease; HR, hazard ratio; MESA, Multi-Ethnic Study of Atherosclerosis; PREVENT, Predicting Risk of
Cardiovascular Disease Events; UKB, UK Biobank.

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