Presenter of 5 Presentations
Cumulative exposure, estimating benefits of early invention of lifetime risk
Reimagining prevention - Using AI and causal estimates to preserve health?
Moving towards personalised prevention, Individual susceptibility?
What is new in prevention in apparently healthy persons?
ESTIMATING THE MAGNITUDE OF LDL-C REDUCTION NEEDED TO OVERCOME THE INCREASED RISK OF ATHEROSCLEROTIC CARDIOVASCULAR EVENTS CAUSED BY LP(A) TO GUIDE CLINICAL MANAGEMENT
Abstract
Background and Aims
Lp(a) increases the risk of atherosclerotic cardiovascular (CV) disease. Current guidelines suggest controlling other CV risk factors, such as LDL-C levels, more intensively in order to reduce the increased risk associated with elevated Lp(a). Therefore, to guide clinical management, we sought to evaluate the magnitude of LDL-C reduction needed to overcome the increased CV risk caused by Lp(a).
Methods
A total of 445,744 UK-Biobank participants were included in the study (mean age: 57.3 years; female sex: 54.3%). We plotted the trajectories of the lifetime risk of major coronary events (a composite of fatal or non-fatal myocardial infarction, or coronary revascularization) associated with increased Lp(a) levels and the equivalent changes in LDL-C levels required to overcome the increased risk caused by various Lp(a) levels.
Results
Our results provide a quantitative estimate of how much LDL-C must be reduced to overcome the increased risk specifically caused by any level of Lp(a). In the table the LDL-C reduction needed to overcome the increased risk caused by Lp(a) is reported based on Lp(a) levels and the age at which LDL-C lowering is started. Notably, the magnitude of LDL-C reduction needed to overcome the increased risk caused by Lp(a) increases with the age at which LDL-C lowering is initiated.
Conclusions
Although no therapies lower Lp(a) specifically, the increased risk caused by Lp(a) can be overcome with additional LDL-C lowering that depends on a person’s Lp(a) level and the age at which LDL-C lowering is started. Our results provide practical guidance for managing increased CV risk caused by Lp(a).