Lipoprotein “little a” [Lp(a)] excess is known to increase risk for cardiovascular disease (CVD) substantially and has been called a “causal” risk factor. Results from the Bruneck Study were published recently in the Journal of the American College of Cardiology. The investigators sought to determine if Lp(a) assessment in the community at large would aid in risk prediction. Lp(a) was measured in 1995 in 826 men and women, ages 45-84 years, from the “general community” who were then followed for 15 years. The researchers used a model that adjusted for both the Framingham Risk Score (FRS) and the Reynolds Risk Score (RRS) to see if Lp(a) would add value to the risk assessment process. Risk prediction based on Lp(a) was improved in all subjects in the general community but was particularly helpful in reclassifying patients at high or low risk in those determined by the traditional risk scores to be in the intermediate risk group. In those determined to be at intermediate risk by FRS or RRS, the net reclassification index improved by 22.5% in subjects who remained free from CVD and by 17.1% for those who were diagnosed with CVD during the study period adding up to a 39.6% improvement in CVD risk prediction overall in this group. Authors concluded that Lp(a) indeed improves CVD risk prediction in the community at large and was particularly beneficial in predicting 15-year CVD outcomes in subjects who are thought to be at intermediate risk by either FRS or RRS.
Reference: Willeit P, Kiechl S, Kronenberg F, et al. Discrimination and net reclassification of cardiovascular risk with Lipoprotein(a) prospective 15-year outcomes in the Bruneck Study. J Am Coll Cardiol. 2014;64(9):851-860. doi:10.1016/j.jacc.2014.03.061