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Global variation in lipoprotein/a levels among patients with coronary heart disease

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dc.contributor.authorBarkas, Fotios
dc.contributor.authorBrandts, Julia
dc.contributor.authorDe Bacquer, Dirk
dc.contributor.authorJennings, Catriona
dc.contributor.authorDe Backer, Guy G.
dc.contributor.authorKotseva, Kornelia
dc.contributor.authorRyden, Lars
dc.contributor.authorLip, Gregory Y. H.
dc.contributor.authorSantos, Raul D.
dc.contributor.authorLibby, Peter
dc.contributor.authorErlund, Iris
dc.contributor.authorGanly, Sandra
dc.contributor.authorVihervaara, Terhi
dc.contributor.authorAdamska, Agnieszka
dc.contributor.authorAbreu, Ana
dc.contributor.authorAlmahmeed, Wael
dc.contributor.authorAmbari, Ade Meidian
dc.contributor.authorGe, Junbo
dc.contributor.authorHasan-Ali, Hosam
dc.contributor.authorHuo, Yong
dc.contributor.authorJankowski, Piotr
dc.contributor.authorJimenez, Rodney M.
dc.contributor.authorLi, Yong
dc.contributor.authorMahmood Zuhdi, Ahmad Syadi
dc.contributor.authorMakubi, Abel
dc.contributor.authorMbakwem, Amam Chinyere
dc.contributor.authorMbau, Lilian
dc.contributor.authorNavarro Estrada, Jose Luis
dc.contributor.authorOgah, Okechukwu Samuel
dc.contributor.authorOgola, Elijah Nyainda
dc.contributor.authorQuintero–Baiz, Adalberto
dc.contributor.authorSani, Mahmoud Umar
dc.contributor.authorSosa Liprandi, Maria Ines
dc.contributor.authorTan, Jack Wei Chieh
dc.contributor.authorUrina Triana, Miguel Alberto
dc.contributor.authorYeo, Tee Joo
dc.contributor.authorWood, David
dc.contributor.authorMcEvoy, John William
dc.contributor.authorRay, Kausik K.
dc.contributor.authorINTERASPIRE Investigators
dc.date.accessioned2025-06-04T13:51:51Z
dc.date.available2025-06-04T13:51:51Z
dc.date.issued2025
dc.description© 2025 by the American College of Cardiology Foundation. Published by Elsevier.pt_PT
dc.description.abstractBackground Lipoprotein(a) [Lp(a)] is a common risk factor for atherosclerotic cardiovascular disease, potentially more atherogenic per particle than low-density lipoprotein. An estimated 1.5 billion individuals globally have elevated levels ≥125 nmol/L, considered as a risk-enhancing threshold. Although Lp(a) levels vary by ethnicity, ongoing trials of novel therapies in predominantly secondary prevention patients use fixed Lp(a) enrollment thresholds. Objectives The purpose of this study was to assess Lp(a) levels in coronary heart disease (CHD) patients across geographical regions, providing inference on the proportions potentially eligible for future Lp(a)-lowering therapies and whether these vary by region and country. Methods INTERASPIRE (International Action on Secondary Prevention through Intervention to Reduce Events)enrolled adults hospitalized with CHD in the previous 6 to 24 months. Lp(a) levels were available in 13 countries across 6 World Health Organization (WHO) regions: Africa (Kenya, Nigeria, Tanzania), Americas (Argentina, Colombia), Eastern Mediterranean (UAE), Europe (Poland, Portugal), South-East Asia (Indonesia), and Western Pacific (China, Malaysia, Philippines, Singapore). Lp(a) measurements were performed once and centrally in Helsinki using an isoform-independent assay for 11 countries, and locally in Indonesia and China with standardization to the core laboratory. Lp(a) levels are reported as median (Q1-Q3) and proportions above different thresholds. Results Lp(a) results were available for 3,928 patients from 13 countries (mean age: 60.2 ± 10.2 years; 21.1% women). Median Lp(a) was 32 nmol/L (Q1-Q3: 11-89 nmol/L) overall, with 17.6% having levels ≥125 nmol/L. Median levels varied by region—highest in Africa (62 nmol/L) and lowest in Western Pacific (22 nmol/L)—and also between countries within regions: Europe (Portugal: 59 nmol/L vs Poland: 19.5 nmol/L), South America (Colombia: 46 nmol/L vs Argentina: 32 nmol/L) and Western Pacific (Malaysia: 39.5 nmol/L vs Philippines: 14 nmol/L). Overall, the proportions of patients with Lp(a) ≥150, 175, and 200 nmol/L (hence eligibility for future Lp(a)-lowering therapies) were 13.0%, 9.3%, and 6.2%, respectively, with eligibility also varying among countries: highest in Portugal (25.5%, 18.3%, and 11.6%) and lowest in Philippines (4.3%, 2.5%, and 1.3%). Conclusions The vast majority of patients with CHD have Lp(a) levels far below what is considered a typical risk-enhancing threshold, suggesting that the attributable risk from Lp(a) is more complex than previously perceived. Furthermore, wide geographical variations in Lp(a) levels above entry criteria for ongoing trials could impact equitable access to therapies, if these trials are positive.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.doi10.1016/j.jacc.2025.04.010pt_PT
dc.identifier.eissn1558-3597
dc.identifier.issn0735-1097
dc.identifier.urihttp://hdl.handle.net/10400.5/101285
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherElsevierpt_PT
dc.relation.publisherversionhttps://www.sciencedirect.com/journal/journal-of-the-american-college-of-cardiologypt_PT
dc.subjectApolipoprotein Bpt_PT
dc.subjectAtherosclerotic cardiovascular diseasept_PT
dc.subjectCardiovascular riskpt_PT
dc.subjectCholesterolpt_PT
dc.subjectCoronary heart diseasept_PT
dc.subjectLipoprotein(a)pt_PT
dc.titleGlobal variation in lipoprotein/a levels among patients with coronary heart diseasept_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage2042pt_PT
oaire.citation.issue21pt_PT
oaire.citation.startPage2028pt_PT
oaire.citation.titleJournal of the American College of Cardiologypt_PT
oaire.citation.volume85pt_PT
person.familyNameAbreu
person.givenNameAna
person.identifier.ciencia-id881A-1343-A491
person.identifier.orcid0000-0003-0786-7830
rcaap.rightsrestrictedAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublication0881e2c9-e3e9-4eff-b1e1-475ca2dfa3fd
relation.isAuthorOfPublication.latestForDiscovery0881e2c9-e3e9-4eff-b1e1-475ca2dfa3fd

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