@article {Nissene002060, author = {Steven E Nissen and Kathy Wolski and Leslie Cho and Stephen J Nicholls and John Kastelein and Eran Leitersdorf and Ulf Landmesser and Michael Blaha and A Michael Lincoff and Ryuichi Morishita and Sotirios Tsimikas and Junhao Liu and Brian Manning and Plamen Kozlovski and Anastasia Lesogor and Tom Thuren and Taro Shibasaki and Florin Matei and F{\'a}bio Serra Silveira and Andreas Meunch and Aysha Bada and Vinod Vijan and Niels Eske Bruun and Borge G Nordestgaard}, editor = {,}, title = {Lipoprotein(a) levels in a global population with established atherosclerotic cardiovascular disease}, volume = {9}, number = {2}, elocation-id = {e002060}, year = {2022}, doi = {10.1136/openhrt-2022-002060}, publisher = {Archives of Disease in childhood}, abstract = {Objective Lipoprotein(a) (Lp(a)) is an important genetically determined risk factor for atherosclerotic vascular disease (ASCVD). With the development of Lp(a)-lowering therapies, this study sought to characterise patterns of Lp(a) levels in a global ASCVD population and identify racial, ethnic, regional and gender differences.Methods A multicentre cross-sectional epidemiological study to estimate the prevalence of elevated Lp(a) in patients with a history of myocardial infarction, ischaemic stroke or peripheral artery disease conducted at 949 sites in 48 countries in North America, Europe, Asia, South America, South Africa and Australia between April 2019 and July 2021. Low-density lipoprotein cholesterol (LDL-C) and Lp(a) levels were measured either as mass (mg/dL) or molar concentration (nmol/L).Results Of 48 135 enrolled patients, 13.9\% had prior measurements of Lp(a). Mean age was 62.6 (SD 10.1) years and 25.9\% were female. Median Lp(a) was 18.0 mg/dL (IQR 7.9{\textendash}57.1) or 42.0 nmol/L (IQR 15.0{\textendash}155.4). Median LDL-C was 77 mg/dL (IQR 58.4{\textendash}101.0). Lp(a) in women was higher, 22.8 (IQR 9.0{\textendash}73.0) mg/dL, than in men, 17.0 (IQR 7.1{\textendash}52.2) mg/dL, p\<0.001. Black patients had Lp(a) levels approximately threefold higher than white, Hispanic or Asian patients. Younger patients also had higher levels. 27.9\% of patients had Lp(a) levels \>50 mg/dL, 20.7\% had levels \>70 mg/dL, 12.9\% were \>90 mg/dL and 26.0\% of patients exceeded 150 nmol/L.Conclusions Globally, Lp(a) is measured in a small minority of patients with ASCVD and is highest in black, younger and female patients. More than 25\% of patients had levels exceeding the established threshold for increased cardiovascular risk, approximately 50 mg/dL or 125 nmol/L.Data are available on reasonable request.}, URL = {https://openheart.bmj.com/content/9/2/e002060}, eprint = {https://openheart.bmj.com/content/9/2/e002060.full.pdf}, journal = {Open Heart} }