Serially increasing change in lipoprotein(a) concentration has predictive value in acute vascular events

Background: Lipoprotein(a) (Lp(a)) has been regarded in some studies as an independent risk factor of atherosclerotic vascular disease. However, the use of a baseline plasma Lp(a) concentration as a screening tool for future acute vascular events (AVE) is controversial. We therefore investigated whether progressively increasing change in plasma Lp(a) concentration is associated with the development of AVE. Methods: We investigated prospective analyses of 985 participants (464 women and 521 men) who had either clinically evident vascular disease (VD group, n = 443) or its risk factor(s) (RF group, n = 542). Blood samples were taken from all participants every six months to measure inflammatory markers such as Lp(a) and C-reactive protein during a 10-year follow-up period. Results: During the follow-up, 223 new cases of myocardial infarction, stroke, and peripheral arterial disease were identified. In the RF group, the relative risk of positive Δ Lp(a) for predicting AVE was 4.36 (95% confidence interval [CI] 1.76-10.85; P = 0.002). In the VD group, the relative risk of positive Δ Lp(a) for predicting AVE was 6.35 (95% CI 3.68-10.97; P < 0.001). Conclusions: These results suggest that a progressively increasing change in Lp(a) concentration has a highly significant predictive value in AVE in both the VD and the RF groups.