%0 Journal Article
%T Impact of Lipoprotein(a) Level on Low-Density Lipoprotein Cholesterol- or Apolipoprotein B-Related Risk of Coronary Heart Disease.
%A Arnold N
%A Blaum C
%A Goßling A
%A Brunner FJ
%A Bay B
%A Zeller T
%A Ferrario MM
%A Brambilla P
%A Cesana G
%A Leoni V
%A Palmieri L
%A Donfrancesco C
%A Ojeda F
%A Linneberg A
%A Söderberg S
%A Iacoviello L
%A Gianfagna F
%A Costanzo S
%A Sans S
%A Veronesi G
%A Thorand B
%A Peters A
%A Tunstall-Pedoe H
%A Kee F
%A Salomaa V
%A Schnabel RB
%A Kuulasmaa K
%A Blankenberg S
%A Waldeyer C
%A Koenig W
%A  
%J J Am Coll Cardiol
%V 84
%N 2
%D 2024 Jul 9
%M 38960510
%F 27.203
%R 10.1016/j.jacc.2024.04.050
%X <B>BACKGROUND: </B>Conventional low-density lipoprotein cholesterol (LDL-C) quantification includes cholesterol attributable to lipoprotein(a) (Lp(a)-C) due to their overlapping densities.<BR><B>OBJECTIVE: </B>The purposes of this study were to compare the association between LDL-C and LDL-C corrected for Lp(a)-C (LDLLp(a)corr) with incident coronary heart disease (CHD) in the general population and to investigate whether concomitant Lp(a) values influence the association of LDL-C or apolipoprotein B (apoB) with coronary events.<BR><B>METHODS: </B>Among 68,748 CHD-free subjects at baseline LDLLp(a)corr was calculated as "LDL-C-Lp(a)-C," where Lp(a)-C was 30% or 17.3% of total Lp(a) mass. Fine and Gray competing risk-adjusted models were applied for the association between the outcome incident CHD and: 1) LDL-C and LDLLp(a)corr in the total sample; and 2) LDL-C and apoB after stratification by Lp(a) mass (≥/<90th percentile).<BR><B>RESULTS: </B>Similar risk estimates for incident CHD were found for LDL-C and LDL-CLp(a)corr30 or LDL-CLp(a)corr17.3 (subdistribution HR with 95% CI) were 2.73 (95% CI: 2.34-3.20) vs 2.51 (95% CI: 2.15-2.93) vs 2.64 (95% CI: 2.26-3.10), respectively (top vs bottom fifth; fully adjusted models). Categorization by Lp(a) mass resulted in higher subdistribution HRs for uncorrected LDL-C and incident CHD at Lp(a) ≥90th percentile (4.38 [95% CI: 2.08-9.22]) vs 2.60 [95% CI: 2.21-3.07]) at Lp(a) <90th percentile (top vs bottom fifth; Pinteraction0.39). In contrast, apoB risk estimates were lower in subjects with higher Lp(a) mass (2.43 [95% CI: 1.34-4.40]) than in Lp(a) <90th percentile (3.34 [95% CI: 2.78-4.01]) (Pinteraction0.49).<BR><B>CONCLUSIONS: </B>Correction of LDL-C for its Lp(a)-C content provided no meaningful information on CHD-risk estimation at the population level. Simple categorization of Lp(a) mass (≥/<90th percentile) influenced the association between LDL-C or apoB with future CHD mostly at higher Lp(a) levels.