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dc.contributor.authorVerbeek, Rutger
dc.contributor.authorHoogeveen, Renate M
dc.contributor.authorLangsted, Anne
dc.contributor.authorStiekema, Lotte CA
dc.contributor.authorVerweij, Simone L
dc.contributor.authorHovingh, G Kees
dc.contributor.authorWareham, Nicholas
dc.contributor.authorKhaw, Kay-Tee
dc.contributor.authorBoekholdt, S Matthijs
dc.contributor.authorNordestgaard, Børge G
dc.contributor.authorStroes, Erik SG
dc.date.accessioned2019-04-05T11:35:49Z
dc.date.available2019-04-05T11:35:49Z
dc.date.issued2018-07-14
dc.identifier.issn0195-668X
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/291163
dc.description.abstractAims: Lipoprotein(a) (Lp(a)) elevation is a causal risk factor for cardiovascular disease (CVD). It has however been suggested that elevated Lp(a) causes CVD mainly in individuals with high low-density lipoprotein cholesterol (LDL-C) levels. We hypothesized that the risk associated with high Lp(a) levels would largely be attenuated at low LDL-C levels. Methods and results: In 16 654 individuals from the EPIC-Norfolk prospective population study, and in 9448 individuals from the Copenhagen City Heart Study (CCHS) parallel statistical analyses were performed. Individuals were categorized according to their Lp(a) and LDL-C levels. Cut-offs were set at the 80th cohort percentile for Lp(a). Low-density lipoprotein cholesterol cut-offs were set at 2.5, 3.5, 4.5, and 5.5 mmol/L. Low-density lipoprotein cholesterol levels in the primary analyses were corrected for Lp(a)-derived LDL-C (LDL-Ccorr). Multivariable-adjusted hazard ratios were calculated for each category. The category with LDL-Ccorr <2.5 mmol/L and Lp(a) <80th cohort percentile was used as reference category. In the EPIC-Norfolk and CCHS cohorts, individuals with an Lp(a) ≥80th percentile were at increased CVD risk compared with those with Lp(a) <80th percentile for any LDL-Ccorr levels ≥2.5 mmol/L. In contrast, for LDL-Ccorr <2.5 mmol/L, the risk associated with elevated Lp(a) attenuated. However, there was no interaction between LDL-Ccorr and Lp(a) levels on CVD risk in either cohort. Conclusion: Lipoprotein(a) and LDL-C are independently associated with CVD risk. At LDL-C levels below <2.5 mmol/L, the risk associated with elevated Lp(a) attenuates in a primary prevention setting.
dc.format.mediumPrint
dc.languageeng
dc.publisherOxford University Press (OUP)
dc.subjectHumans
dc.subjectCardiovascular Diseases
dc.subjectLipoprotein(a)
dc.subjectRisk Assessment
dc.subjectProspective Studies
dc.subjectPrimary Prevention
dc.subjectMiddle Aged
dc.subjectFemale
dc.subjectMale
dc.subjectCholesterol, LDL
dc.titleCardiovascular disease risk associated with elevated lipoprotein(a) attenuates at low low-density lipoprotein cholesterol levels in a primary prevention setting.
dc.typeArticle
prism.endingPage2596
prism.issueIdentifier27
prism.publicationDate2018
prism.publicationNameEur Heart J
prism.startingPage2589
prism.volume39
dc.identifier.doi10.17863/CAM.38345
dcterms.dateAccepted2018-05-30
rioxxterms.versionofrecord10.1093/eurheartj/ehy334
rioxxterms.versionAM
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2018-07
dc.contributor.orcidWareham, Nicholas [0000-0003-1422-2993]
dc.contributor.orcidKhaw, Kay-Tee [0000-0002-8802-2903]
dc.identifier.eissn1522-9645
rioxxterms.typeJournal Article/Review
pubs.funder-project-idMedical Research Council (MC_UU_12015/1)
pubs.funder-project-idMedical Research Council (G1000143)
pubs.funder-project-idDepartment of Health (via National Institute for Health Research (NIHR)) (NF-SI-0617-10149)
pubs.funder-project-idDepartment of Health (via National Institute for Health Research (NIHR)) (NF-SI-0512-10135)
cam.issuedOnline2018-06-21
rioxxterms.freetoread.startdate2019-06-21


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