Elevated Lp(a) Emerges as a Key Driver of Atherosclerosis in Chinese Adults

Elevated lipoprotein(a) (Lp(a)) is a significant risk factor for subclinical atherosclerosis among Chinese adults, according to research published in the Journal of the American College of Cardiology.

“Elevated [Lp(a)] is strongly associated with an increased risk of atherosclerotic cardiovascular disease; yet large-scale studies on the epidemiology of elevated Lp(a) as well as its association with subclinical atherosclerosis in the Chinese population are limited,” according to the study authors.

The researchers estimated the prevalence of elevated Lp(a) in a large adult population that was evaluated and underwent imaging of the carotid artery, brain, and coronary artery at health check-up centers across 30 Chinese provinces. They also tested the association of elevated Lp(a) with both site-specific and multisite subclinical atherosclerosis.

Among a total of 2,788,206 patients, the prevalence of Lp(a) >30 mg/dL was 18.67% and 8.41% were greater than 50 mg/dL. The researchers noted that the prevalence was significantly higher among women, older adults, and people with various cardio-renal-metabolic risk factors.

Compared to patients with Lp(a) ≤30 mg/dL, those with Lp(a) between more than 30 and 50 mg/dL had greater odds of increased carotid intima-media thickness of 11%, carotid plaque of 15%, subclinical brain infarcts of 9%, and coronary artery calcification of 11%. Those odds were higher when comparing patients with Lp(a) more than 50 mg/dL to those with Lp(a) less than or equal to 30 mg/dL.

The study also found significant associations between elevated Lp(a) and the extent of coronary artery calcification and subclinical atherosclerosis at sites one, two, and three, with stronger associations in cases with a severe extent and multisite involvement.

“A significant burden of elevated Lp(a) was found in China, highlighting the necessity of prioritized Lp(a) screening in high-risk groups,” wrote the authors.

The findings suggest that individuals with elevated Lp(a) should undergo a comprehensive assessment of subclinical atherosclerosis at multiple sites to help prevent atherosclerotic cardiovascular disease.

Reference:

Man S, et al. J Am Coll Cardiol.  2025 Apr 2:S0735-1097(25)05277-5. doi:10.1016/j.jacc.2025.02.032