{"id":"942887c4bf95","type":"article","url":"https://hartvaat.nl/2024/04/01/lp-a-en-hscrp-als-cv-risicofactoren-primaire-en-secundaire-preventie/","title":"Lp(a) en hsCRP als CV-risicofactoren: primaire en secundaire preventie","title_en":"Lipoprotein(a), C-Reactive Protein, and Cardiovascular Risk in Primary and Secondary Prevention Populations.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["biomarkers-cardiovasculair","inflammatie","lipide-aferese","lipoproteïne-a","lipoproteïne-a-therapeutisch-doel","secundaire-preventie","slaapapneu"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2023.5605","source_url":"https://doi.org/10.1001/jamacardio.2023.5605","authors":["Aeron M Small","Ashley Pournamdari","Giorgio E M Melloni","Benjamin M Scirica","Deepak L Bhatt","Itamar Raz","Eugene Braunwald","Robert P Giugliano","Marc S Sabatine","Gina M Peloso","Nicholas A Marston","Pradeep Natarajan"],"significance":7,"published":"2024-04-01","source_date":"2024-04-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"This analysis showed that Lp(a) and hsCRP independently predict cardiovascular risk in both primary and secondary prevention populations, supporting measurement of both biomarkers for comprehensive residual risk assessment.","created":"2026-07-03T10:30:51Z","updated":"2026-07-03T13:29:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JACC-analyse toonde dat Lp(a) en hsCRP onafhankelijk cardiovasculair risico voorspellen in zowel primaire als secundaire preventie. De combinatie identificeert patiënten die baat hebben bij gerichte anti-inflammatoire of Lp(a)-verlagende therapie.","abstract_original":"IMPORTANCE: Elevated lipoprotein(a) (Lp[a]) is a putative causal risk factor for atherosclerotic cardiovascular disease (ASCVD). There are conflicting data as to whether Lp(a) may increase cardiovascular risk only in the presence of concomitant inflammation. OBJECTIVE: To investigate whether Lp(a) is associated with cardiovascular risk independent of high-sensitivity C-reactive protein (hs-CRP) in both primary and secondary prevention populations. DESIGN, SETTING, AND PARTICIPANTS: This cohort study uses data from 3 distinct cohorts, 1 population-based cohort and 2 randomized clinical trials. Participants included individuals from the UK Biobank (data from 2006-2010) without prevalent ASCVD, participants in the FOURIER (TIMI 59) trial (data from 2013-2017) who had baseline Lp(a) and hs-CRP data, and participants in the SAVOR-TIMI 53 trial (data from 2010-2013) who had prevalent ASCVD and baseline values for Lp(a) and hs-CRP. The data analysis took place from November 2022 to November 2023. EXPOSURE: Baseline plasma Lp(a), considered either as a continuous variable or dichotomized at 125 nmol/L. MAIN OUTCOMES AND MEASURES: Risk of major adverse cardiovascular events (MACE) (composite of cardiovascular death, myocardial infarction [MI], or ischemic stroke), the individual MACE components, and peripheral artery disease (PAD). RESULTS: Among 357 220 individuals in the UK Biobank without prevalent ASCVD, 232 699 (65%) had low hs-CRP (<2 mg/L), and 124 521 (35%) had high hs-CRP (≥2 mg/L) values. In a Cox proportional hazard model adjusted for ASCVD risk factors, higher Lp(a) was associated with increased cardiovascular risk regardless of baseline hs-CRP value for MACE (hs-CRP ≥2 mg/L: hazard ratio [HR] per 50-nmol/L higher Lp[a], 1.05; 95% CI, 1.04-1.07; P < .001; for hs-CRP <2 mg/L: HR, 1.05; 95% CI, 1.04-1.07; P < .001; P = .80 for interaction), as well as MI, ischemic stroke, and PAD individually. Among 34 020 individuals in the FOURIER and SAVOR trials with baseline cardiometabolic disease, there were 17 643 (52%) with low and 16 377 (48%) with high baseline hs-CRP values. In Cox proportional hazard models using aggregated data from FOURIER and SAVOR, higher baseline Lp(a) was associated with increased cardiovascular risk regardless of baseline hs-CRP for MACE (hs-CRP ≥2 mg/L: HR per 50-nmol/L higher Lp[a], 1.02; 95% CI, 1.00-1.05; P = .04; hs-CRP <2 mg/L: HR, 1.05; 95% CI, 1.02-1.08; P < .001; P = .16 for interaction), MI, and PAD. CONCLUSIONS AND RELEVANCE: In this study, higher levels of Lp(a) were associated with MACE, MI, and PAD in both primary and secondary prevention populations regardless of baseline hs-CRP value."}