Background: Lipoprotein(a) [Lp(a)] is associated with atherosclerotic cardiovascular disease. An Lp(a) threshold of ≥125 nmol/L is commonly used to identify individuals at higher risk for events, but there is a paucity of data on those of Hispanic/Latino descent.
Methods: We evaluated the association between Lp(a) and myocardial infarction (MI), ischemic stroke, and all-cause mortality among 16,117 Hispanic Community Health Study/Study of Latinos (HCHS/SOL) individuals. Event rates were compared across Lp(a) quintiles. Multivariable Cox proportional hazard models assessed the relationship between events and Lp(a) across increasing quintiles, log-transformed Lp(a), and ≥ versus <125 nmol/L. Sampling weights and survey methods were used to account for the stratified probability sampling of the cohort.
Results: Among the HCHS/SOL target population (median age 41.1 years, 52.4% female), the median Lp(a) was 19.7 nmol/L (quartile 1-3, 7.3-60.6), with 11.4% having Lp(a) ≥125 nmol/L, and the highest Lp(a) quintile was defined as >77 nmol/L. Over a median follow-up of 9.8 years, 883 events (135 MI, 99 stroke, 649 all-cause mortality) occurred. The age-adjusted incidence rate of the composite events (MI, stroke, and all-cause mortality) was 505.2 per 100,000 person-years. After multivariable adjustment, each 1-SD increase in log-transformed Lp(a) was associated with a higher risk of MI (HR 1.47, 95% CI 1.14-1.89). Compared with Lp(a) <125 nmol/L, elevated Lp(a) ≥125 nmol/L conferred an increased risk of MI (HR 2.29, 95% CI 1.45-3.63), all-cause mortality (HR 1.43, 95% CI 1.05-1.93), and composite events (HR 1.56, 95% CI 1.22-2.01), but not stroke. Findings were consistent when comparing the highest Lp(a) quintile to the lower four quintiles, but the elevated risk was observed only for MI and composite events.
Conclusion: Hispanic/Latino individuals with elevated Lp(a) are at an increased risk of MI and all-cause mortality. Although Lp(a) ≥125 nmol/L is a valid risk threshold, Hispanics/Latinos show a continuous relationship between increasing Lp(a) levels and MI risk.
Editors
Editor-in-Chief
Harlan M. Krumholz, MD, SM, FACC
CME Editor
Ragavendra R. Baliga, MD
Authors
Priscilla Duran-Luciano, MD
Alexandrina Danilov, MD
J. Antonio G. López, MD
Shia T. Kent, PhD
John N. Booth III, PhD
Leandro Slipczuk, MD
Ann Marie Navar, MD, PhD
Santica M Marcovina, PhD, ScD
Parag H. Joshi, MD
Carlos J. Rodriguez, MD, MPH
Important Dates
Date of Release: December 1, 2025
Term of Approval/Date of CME/MOC Expiration: November 30, 2026