{"id":"53a3b2465271","type":"article","url":"https://hartvaat.nl/2026/05/24/lp-a-japan-verhoogd-lp-a-blijft-risicovol-ondanks-ldl-onder-55-mg-dl/","title":"Lp(a)-JAPAN: verhoogd Lp(a) blijft risicovol ondanks LDL onder 55 mg/dl","title_en":"Lipoprotein(a) and residual cardiovascular risks in Japanese patients with coronary artery disease who achieve guideline-recommended LDL-C goals.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":["anemie-ckd","diabetes-type-2","dyslipidemie","eas-2026","ezetimibe","ldl-cholesterol","lipide-aferese","lipoproteïne-a","statines"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehag446","source_url":"https://doi.org/10.1093/eurheartj/ehag446","authors":["Yu Kataoka","Kausik K Ray","Stephen J Nicholls","Aya Katasako-Yabumoto","Satoshi Kitahara","Hayato Hosoda","Kentarou Mitsui","Kota Murai","Kenichiro Sawada","Hideo Matama","Takamasa Iwai","Satoshi Honda","Masashi Fujino","Shuichi Yoneda","Kazuhiro Nakao","Kensuke Takagi","Yasuhide Asaumi","Teruo Noguchi"],"significance":7,"published":"2026-06-05","source_date":"2026-05-24","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"eas-2026","summary_en":"This observational study in 1,581 Japanese patients with coronary artery disease after PCI shows that elevated Lp(a) remains associated with more cardiovascular events even when LDL-C is well controlled (<55 mg/dL). At Lp(a) ≥50 mg/dL the standardised 5-year MACE risk was nearly seven times higher than at Lp(a) <30 mg/dL. The risk threshold sat around 28 mg/dL — lower than values used in Western populations. Intensive LDL lowering thus partly attenuates, but does not eliminate, Lp(a)-related risk.","created":"2026-07-03T10:32:15Z","updated":"2026-07-03T13:31:13Z","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":"Deze observationele studie bij 1.581 Japanse patiënten met coronairlijden na PCI laat zien dat een verhoogd Lp(a) ook bij goed gereguleerd LDL-C (<55 mg/dl) gepaard blijft met meer cardiovasculaire events. Bij Lp(a) ≥50 mg/dl was het gestandaardiseerde 5-jaars-MACE-risico bijna zeven keer hoger dan bij Lp(a) <30 mg/dl. De drempelwaarde voor verhoogd risico lag rond 28 mg/dl — lager dan in westerse populaties wordt aangehouden. Strikte LDL-verlaging dempt het Lp(a)-risico dus deels, maar heft het niet op.","abstract_original":"BACKGROUND AND AIMS: Current guidance recommends better low-density lipoprotein cholesterol (LDL-C) control in patients with elevated lipoprotein(a) [Lp(a)] as Lp(a) lowering therapies are unavailable. Whether risks attributable to Lp(a) are mitigated in patients with coronary artery disease (CAD) who achieve LDL-C <55 mg/dL remains unknown. METHODS: Multicentre retrospective observational study analysing 1581 Japanese patients with CAD [Lp(a)-JAPAN: jRCT1050260016]. Risk of major adverse cardiovascular events (MACE) (cardiac death + non-fatal myocardial infarction + coronary revascularization in non-culprit segments) was compared according to Lp(a) levels (<30, ≥30 and <50, and ≥50 mg/dL) and among LDL-C strata (<55 mg/dL vs ≥55 mg/dL) 8 weeks after percutaneous coronary intervention. RESULTS: During the 5.1-year observation among patients with LDL-C ≥55 mg/dL (n=1069), MACE occurred in 21.3% with risk of MACE increasing with Lp(a) levels (3.9, 7.9 and 11.0 events per 100 person-years for <30 mg/dL, ≥30 and <50 mg/dL, and ≥50 mg/dL, respectively; log-rank p<0.001). Among those with LDL-C <55 mg/dL (n=512), the proportion with MACE was lower overall (4.3%, p<0.001). However, elevated Lp(a) levels still identified those at higher risk of MACE (1.4, 4.7 and 7.5 events per 100 person-years in Lp(a) <30 mg/dL, ≥30 and <50 mg/dL, and ≥50mg/dL, respectively; p<0.001). Standardized 5-year MACE rate was over twice and five times higher in patients with Lp(a) ≥30 and <50 mg/dL (17.0%; adjusted hazard ratio [HR] 3.80, 95% confidence interval [CI] 1.78-8.11, p<0.001) and ≥50 mg/dL (33.4%; adjusted HR 6.90, 95% CI 3.53-13.46, p<0.001) compared to Lp(a) <30 mg/dL (5.0%). The receiver-operating characteristic analyses identified Lp(a) ≥28.2 mg/dL as the threshold for MACE (area under the curve 0.68, p<0.001). CONCLUSIONS: Whilst lower achieved LDL-C attenuates in part the risk from Lp(a), elevated Lp(a) levels still associate with worse cardiovascular outcomes. The Lp(a) threshold among Japanese patients with CAD at risk of recurrent events appears lower than in Caucasian populations, which merits further evaluation."}