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Elevated lipoprotein(a) [lp(a)] levels and coronary artery calcium (CAC) scores both portend heightened risk for atherosclerotic cardiovascular disease (ASCVD). But how do lp(a) and CAC interact, and can CAC scores be used to risk stratify people with high lp(a) levels? Authors pooled four large observational studies to identify >11,000 patients (mean age, 56) without known ASCVD for whom both lp(a) and CAC results were available.
After average follow-up of almost 15 years, lp(a) >50 mg/dl and CAC >0 both were associated with significantly higher risk for ASCVD.
In those with CAC of 0, elevated lp(a) was associated with 28% higher relative risk for ASCVD events, although absolute rates remained low (4.9 events/1000 person-ye…