Association of Lp(a) with Cardiovascular Disease and All-cause Mortality in US Hispanics and Latinos (JACC December 2025-1)-Article: ar Disease and All-cause Mortality in US Hispanics and Latinos Contact: Collin Grabarek Title:

Article: ar Disease and All-cause Mortality in US Hispanics and Latinos Contact: Collin Grabarek Title:

Pdf Summary

This large, prospective study from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) investigated the relationship between lipoprotein(a) [Lp(a)] levels and cardiovascular risk and mortality in 16,117 U.S. Hispanic/Latino adults over a median 9.8 years. Lp(a) is a genetically determined lipoprotein associated with atherosclerotic cardiovascular disease (ASCVD), but data on its risk implications in Hispanic/Latino populations have been limited.<br /><br />Key findings include:  <br />- Median Lp(a) level in this cohort was 19.7 nmol/L, with 11.4% having elevated Lp(a) ≥125 nmol/L, a cutoff commonly used to identify increased ASCVD risk in other populations.  <br />- Elevated Lp(a) ≥125 nmol/L was associated with significantly higher risks of myocardial infarction (MI) (hazard ratio [HR]: 2.29), all-cause mortality (HR: 1.43), and a composite outcome (HR: 1.56) but not stroke. Similar increased MI risk was observed when comparing the highest Lp(a) quintile (≥77 nmol/L) to lower levels.  <br />- The relationship between increasing Lp(a) levels and MI risk was continuous and linear rather than threshold-based.  <br />- Genetic ancestry influenced Lp(a) levels and risk: individuals with higher African or European ancestry had higher Lp(a) levels and stronger associations with MI risk, while those with higher Amerindian ancestry had lower Lp(a) and did not show this association.  <br />- No significant association was found between Lp(a) and ischemic stroke risk.  <br />- Age-stratified analyses suggested Lp(a)-associated MI risk was more prominent in those over 44 years old.  <br />- Acculturation factors showed complex, inconsistent influences on the Lp(a)-MI risk relationship.  <br /><br />This study fills a critical knowledge gap by providing evidence that elevated Lp(a) is a significant risk factor for MI and mortality in U.S. Hispanic/Latino adults, supporting Lp(a)-inclusive cardiovascular risk assessment in this diverse and historically understudied group. The observed continuous risk relationship argues against relying on rigid Lp(a) thresholds alone. Findings highlight the importance of considering genetic ancestry in interpreting Lp(a) risk and underscore the need for inclusive clinical trials and guidelines that reflect Hispanic/Latino population risk profiles. Limitations include limited power for stroke analysis and mortality subtypes and lack of causality due to observational design.<br /><br />In summary, elevated Lp(a), particularly ≥125 nmol/L, independently predicts higher MI and all-cause mortality risk in U.S. Hispanic/Latino adults with a continuous dose-response relationship, affirming Lp(a)’s role as a valuable marker for cardiovascular risk stratification in this population.

Keywords

Lipoprotein(a)

Lp(a) levels

Cardiovascular risk

Myocardial infarction

Hispanic/Latino adults

Genetic ancestry

Mortality risk

Atherosclerotic cardiovascular disease

HCHS/SOL study

Dose-response relationship