Significant variation in the levels of lipoprotein(a) Lp(a) was found across a diverse population of Hispanic and Latino adults living in the U.S., and may have important implications for atherosclerotic cardiovascular disease (ASCVD) risk assessment in this undertreated group, according to an analysis from a large-scale cohort study published May 24 in JAMA Cardiology.

Parag H. Joshi, MD, MHS, et al., conducted the analysis to determine the distribution of Lp(a) levels by key demographic groups using data from the prospective, population-based Hispanic Community Health Study/Study of Latinos (HCHS/SOL) cohort. Participants’ cultural backgrounds were Central American, Cuban, Dominican, Mexican, Puerto Rican and South American. Data for this analysis were collected from April 2021 to April 2023. Sampling weights and survey methods were used to evaluate the subset of HCHS/SOL participants.

Results showed that Lp(a) molar concentration was measured in 16,117 participants (mean age, 41 years; 52% women) and the median Lp(a) level was 19.7 (IQR, 7.4-59.7) nmol/L. Higher median Lp(a) values were observed among older age groups and among women, and was higher among participants with vs. without prevalent ASCVD (24.7 vs. 19.3 nmol/L; p<0.001).

There were significant differences in median Lp(a) levels across Hispanic and Latino groups. Among participants reporting a Mexican vs. Dominican background, this ranged from 12 to 41 nmol/L. For those with a West African genetic ancestry, the median Lp(a) was lowest in the first quintile of Lp(a) level and highest in the fifth quintile (5.5% and 12.1%, respectively; p<0.001), and the opposite was observed in participants with an Amerindian ancestry (32.8% and 10.7%; p<0.001).

In a related editorial comment, Sadiya S. Khan, MD, MSc, states that while there is growing evidence supporting the potential to use Lp(a) for risk stratification in ASCVD, challenges remain in defining a cut point for what constitutes a high Lp(a) concentration across different racial and ethnic groups. The cross-sectional nature of this study limits its findings. Longitudinal follow-up for population-based samples isneeded to determine the relative association between Lp(a) concentrations and ASCVD. The current study underscores the need for this research to define a universal risk threshold, “particularly as novel therapies that lower Lp(a) may soon become available.”

Clinical Topics: Dyslipidemia, Advanced Lipid Testing, Lipid Metabolism

Keywords: Lipoprotein(a), Cohort Studies, Cardiovascular Diseases, Cross-Sectional Studies, Prospective Studies, Follow-Up Studies

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