Results:

A total of 29,069 patients (mean age 62 years, 28% women) were included in this analysis. A total of 5,751 events were identified over 95,576 person-years. Associations of baseline and on-statin treatment lipoprotein(a) with CVD risk were approximately linear, with increased risk at lipoprotein(a) values of ≥30 mg/dl for baseline lipoprotein(a) and ≥50 mg/dl for on-statin lipoprotein(a). Initiation of statin therapy reduced low-density lipoprotein cholesterol (LDL-C) (mean change –39% [95% confidence interval, –43 to –35]) without a significant change in lipoprotein(a). Lipoprotein(a) levels were positively associated with increased risk for CV events. Compared to lipoprotein(a) of <15 mg/dl, risk for events increased from 1.04 (95% confidence interval, 0.91–1.18) for 15 mg/dl to <30 mg/dl, to 1.11 (1.00–1.22) for 30 mg/dl to <50 mg/dl, and 1.31 (1.08–1.58) for ≥50 mg/dl after adjustment for age and sex. For patients on statin therapy, the risks were slightly higher, ranging from 0.94 (0.81–1.10) for 15 mg/dl to <30 mg/dl, to 1.43 (1.15–1.76) for ≥50 mg/dl. Risk was similar after further adjustment for previous CVD, diabetes, smoking, systolic blood pressure, LDL-C, and high-density lipoprotein cholesterol. Risk related to lipoprotein(a) was stronger among patients on statins and at younger ages.