@article{01JW8PV3Y9SWVWXBQZ2HC5V9HD,
  abstract     = {{Background
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.}},
  author       = {{Barkas, Fotios and Brandts, Julia and De Bacquer, Dirk and Jennings, Catriona and De Backer, Gui and Kotseva, Kornelia and Ryden, Lars and Lip, Gregory Y.H. and Santos, Raul D. and Libby, Peter and Erlund, Iris and Ganly, Sandra and Vihervaara, Terhi and Adamska, Agnieszka and Abreu, Ana and Almahmeed, Wael and Ambari, Ade Meidian and Ge, Junbo and Hasan-Ali, Hosam and Huo, Yong and Jankowski, Piotr and Jimenez, Rodney M. and Li, Yong and Mahmood Zuhdi, Ahmad Syadi and Makubi, Abel and Mbakwem, Amam Chinyere and Mbau, Lilian and Navarro Estrada, Jose Luis and Ogah, Okechukwu Samuel and Ogola, Elijah Nyainda and Quintero–Baiz, Adalberto and Sani, Mahmoud Umar and Sosa Liprandi, Maria Ines and Tan, Jack Wei Chieh and Urina Triana, Miguel Alberto and Yeo, Tee Joo and Wood, David and McEvoy, John William and Ray, Kausik K. and McEvoy, J.W. and Wood, D. and Adamska, A. and Erlund, I. and Ganly, S. and Jennings, C. and Kotseva, K. and Lip, G.Y.H. and Ray, K. and Rydén, L. and Abreu, A. and Almahmeed, W. and Ambari, A.M. and Ge, J.B. and Hasan-Ali, H. and Huo, Y. and Jankowski, P. and Jimenez, R. and Li, Y. and Mahmood Zuhdi, A.S. and Makubi, A. and Mbakwem, A.C. and Mbau, L. and Navarro Estrada, J.L. and Ogah, O.S. and Ogola, E. and Quintero-Baiz, A. and Sani, M.U. and Sosa Liprandi, M.I. and Tan, J.W.C. and Urina Triana, M. and Yeo, T.J. and Wood, D.A. and Adamska, A. and Jennings, C. and Kotseva, K. and Ganly, S. and Zekic, A. and Rydén, L. and Salako, D. and Toulouse, C. and Chhabra, G. and Spragg, R. and Sullivan, M. and Erlund, I. and Jarvensivu, E. and Vihervaara, T. and Deschle, H.A. and Estrada, JL Navarro and Liprandi, MI Sosa and Bellia, S. and Villarreal, R. and Elfman, M. and Perea, J. and Lombardi, F. and Masson, W. and Castaño, B. and Gamarra, A. and Llamedo, M. and Santander, P. and Barco, A. and Flores, V. and Leyes, C. and Rodríguez, F. and Marturano, M.P. and Alustiza, W.R. and Duronto, E. and Procopio, G. and Higa, C. and Corigliano, O. and Sanchez, M.A. and del Cristo Mendoza Beltrán, F. and Luna, P. and Urina Triana, M.A. and Quintero-Baiz, A. and Renowitsky, C. and Pulgar, M. and Lievano, J. and Hernandez, A. and Cordoba, G. and Duque, M. and Duque, L. and Mendoza, F. and Rojas, J. and Jaramillo, N. and Zuluaga, S. and Restrepo, A. and Munos, J. and Buitrago, A. and Ramirez, H. and Figueroa, F. and Gonzales, C. and Cadena, A. and Bermudez, S. and Gomez, L. and Firdaus, I. and Dwiputra, B. and Arityanti, D. and Susilowati, E. and Hamdani, R. and Syaoqi, M. and Ridwan, M. and Fitra ND, M. and Ridwan, M. and Hartopo, A.B. and Arso, I.A. and Anggraeni, V.Y. and Raynaldo, A.H. and Hasan, H. and Siregar, Y.F. and Tjahjono, C.T. and Sihotang, F.A. and Erickatulistiawan, G. and Tiksnadi, B.B. and Febrianora, M. and Tarsidin, N.F. and Fong, A.Y.Y. and Ahmad, WA Wan and Zuhdi, AS Mahmood and Zuhdi, AS Mahmood and Ahmad, WA Wan and Hadi, M.F. and Kassim, Z Abu and Shaharudin, N.A. and Mohamad Sithik, M.N. and Moussa, I 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Siedlaczek, M. and Skonieczny, G. and Kostrzewa, P. and Gąsior, Z. and Maciejowski, Ł. and Matla-Hajzyk, M. and Hapeta-Zeman, B. and Szóstak-Janiak, K. and Kosior, D. and Kulak, P. and Rajska, E. and Kosior, D. and Rak, A. and Jankowski, P. and Koczwarska-Maciejek, D. and Wolfshaut-Wolak, R. and Gonçalves, L. and Pereira, H. and Abreu, A. and Carvalho, M. and Amador, A. and Calvão, J. and Costa, C. and Moreira, H. and Palma, P. and Pinto, R. and Proença, T. and Rocha, M. and Moreira, N. and Almeida, J. and Batista, G. and Borges-Rosa, J. and Campos, G. and Fernandes, C. and Guimarães, J. and Martinho, S. and Santos, T. and Silva, A. and Simões, M. and Morais, J. and Carvalho, M. and Gonçalves, C. and Martins, A. and Vazão, A. and Abreu, A. and Alves da Silva, P. and Brito, J. and Pires, M Lemos and Lima Martins, A.M. and Pinto, F. and Pinto, R. and Aguiar, C. and Amador, R. and Bello, R. and Lima, R. and Pais, J. and Almeida, A. and Caria, M. and Carrington, M. and Conde, D. and Francisco, C. and Kongo, K. and Patricio, L. and Peralta, M. and Rebola, E. and Rocha, R. and Silva, F. and Trinca, M. and INTERASPIRE Investigators, [missing]}},
  issn         = {{0735-1097}},
  journal      = {{JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY}},
  keywords     = {{apolipoprotein B,atherosclerotic cardiovascular disease,cardiovascular risk,cholesterol,coronary heart disease,lipoprotein (a),CARDIOVASCULAR RISK,APOLIPOPROTEIN-B}},
  language     = {{eng}},
  number       = {{21}},
  pages        = {{2028--2042}},
  title        = {{Global variation in lipoprotein(a) levels among patients with coronary heart disease : insights from the INTERASPIRE study and implications for emerging Lp(a)-lowering therapies}},
  url          = {{http://doi.org/10.1016/j.jacc.2025.04.010}},
  volume       = {{85}},
  year         = {{2025}},
}

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