# Lp(a) en LDL-cholesterol: onafhankelijke CV-risicopaden

*geplaatst 2025-01-28 · Cholesterol · Circulation · doi 10.1161/CIRCULATIONAHA.124.069556 · https://hartvaat.nl/2025/01/28/lp-a-en-ldl-cholesterol-onafhankelijke-cv-risicopaden/*

Analyse bevestigde dat Lp(a) en LDL-cholesterol onafhankelijke cardiovasculaire risicopaden vertegenwoordigen. Verlaging van beide is nodig voor optimale risicoreductie, wat dubbele therapie ondersteunt.

## English: Independence of Lipoprotein(a) and Low-Density Lipoprotein Cholesterol-Mediated Cardiovascular Risk: A Participant-Level Meta-Analysis.

This participant-level analysis confirmed that Lp(a) and LDL cholesterol represent independent cardiovascular risk pathways, supporting the concept that both must be addressed for comprehensive atherosclerotic risk reduction.

## Abstract (original, from the publication)

BACKGROUND: Low-density lipoprotein cholesterol (LDL-C) and lipoprotein(a) (Lp[a]) levels are independently associated with atherosclerotic cardiovascular disease (ASCVD). However, the relationship between Lp(a) level, LDL-C level, and ASCVD risk at different thresholds is not well defined. METHODS: A participant-level meta-analysis of 27 658 participants enrolled in 6 placebo-controlled statin trials was performed to assess the association of LDL-C and Lp(a) levels with risk of fatal or nonfatal coronary heart disease events, stroke, or any coronary or carotid revascularization (ASCVD). The multivariable-adjusted association between baseline Lp(a) level and ASCVD risk was modeled continuously using generalized additive models, and the association between baseline LDL-C level and ASCVD risk by baseline Lp(a) level by Cox proportional hazards models with random effects. The joint association between Lp(a) level and statin-achieved LDL-C level with ASCVD risk was evaluated using Cox proportional hazards models. RESULTS: Compared with an Lp(a) level of 5 mg/dL, increasing levels of Lp(a) were log-linearly associated with ASCVD risk in statin- and placebo-treated patients. Among statin-treated individuals, those with Lp(a) level >50 mg/dL (≈125 nmol/L) had increased risk across all quartiles of achieved LDL-C level and absolute change in LDL-C level. Even among those with the lowest quartile of achieved LDL-C level (3.1-77.0 mg/dL), those with Lp(a) level >50 mg/dL had greater ASCVD risk (hazard ratio, 1.38 [95% CI, 1.06-1.79]) than those with Lp(a) level ≤50 mg/dL. The greatest risk was observed with both Lp(a) level >50 mg/dL and LDL-C level in the fourth quartile (hazard ratio, 1.90 [95% CI, 1.46-2.48]). CONCLUSIONS: These findings demonstrate the independent and additive nature of Lp(a) and LDL-C levels for ASCVD risk, and that LDL-C lowering does not fully offset Lp(a)-mediated risk.

Auteurs: Harpreet S Bhatia, Simon Wandel, Peter Willeit, Anastasia Lesogor, Keith Bailey, Paul M Ridker, Paul Nestel, John Simes, Andrew Tonkin, Gregory G Schwartz, Helen Colhoun, Christoph Wanner, Sotirios Tsimikas

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Bron: Circulation, https://doi.org/10.1161/CIRCULATIONAHA.124.069556. Bijgewerkt 2026-07-03T13:30:28Z. 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.