RT Journal Article SR Electronic T1 Lipoprotein(a) levels in a global population with established atherosclerotic cardiovascular disease JF Open Heart JO Open Heart FD British Cardiovascular Society SP e002060 DO 10.1136/openhrt-2022-002060 VO 9 IS 2 A1 Steven E Nissen A1 Kathy Wolski A1 Leslie Cho A1 Stephen J Nicholls A1 John Kastelein A1 Eran Leitersdorf A1 Ulf Landmesser A1 Michael Blaha A1 A Michael Lincoff A1 Ryuichi Morishita A1 Sotirios Tsimikas A1 Junhao Liu A1 Brian Manning A1 Plamen Kozlovski A1 Anastasia Lesogor A1 Tom Thuren A1 Taro Shibasaki A1 Florin Matei A1 Fábio Serra Silveira A1 Andreas Meunch A1 Aysha Bada A1 Vinod Vijan A1 Niels Eske Bruun A1 Borge G Nordestgaard A1 , YR 2022 UL http://openheart.bmj.com/content/9/2/e002060.abstract AB 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 7.9–57.1) or 42.0 nmol/L (IQR 15.0–155.4). Median LDL-C was 77 mg/dL (IQR 58.4–101.0). Lp(a) in women was higher, 22.8 (IQR 9.0–73.0) mg/dL, than in men, 17.0 (IQR 7.1–52.2) 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.