News · Longevity & Aging
High lipoprotein(a) raised heart risk as much after 70 as before, in 103,341 Danes aged 20 to 100
Lipoprotein(a) is an inherited cholesterol particle most people have never been tested for. A large Danish cohort found its risk does not fade in old age, and matters most there in absolute terms.
- An observational study of 103,341 Danes aged 20 to 100, followed for about 12 years.
- Lipoprotein(a), or Lp(a), is a cholesterol-carrying particle whose level is set largely by genes.
- Each 50 mg/dL higher Lp(a) went with 12% to 18% higher heart and stroke risk at every age.
- Because older people have more events, the extra cases linked to high Lp(a) were far larger after 70.
- It shows the risk persists with age; it does not show that lowering Lp(a) prevents events.
Most people know their LDL cholesterol number. Very few know their lipoprotein(a), a close cousin that is set largely by genes, barely moved by diet or exercise, and missing from the standard cholesterol test. Heart specialists have grown steadily more concerned about it, and a question has hung over its importance in older people: does an inherited risk factor still matter at 80?
A study in Circulation followed 103,341 Danes aged 20 to 100 for about 12 years. High lipoprotein(a) raised the risk of heart attack and stroke by about the same proportion at every age, and because older people have more of these events, the extra toll was largest after 70.
What lipoprotein(a) is
Cholesterol travels through the blood on particles called lipoproteins; MedlinePlus notes, for example, that LDL stands for low-density lipoprotein. It also describes the problem with too much of it: if you have too much cholesterol in your blood, it can combine with other substances in the blood to form plaque.
Lipoprotein(a), often written Lp(a), is a lipoprotein built like LDL with an extra protein attached. That extra piece seems to make it especially good at promoting plaque and clotting. The authors describe high lipoprotein(a) as considered a causal risk factor for atherosclerotic cardiovascular diseases, meaning heart attacks, strokes and related conditions caused by plaque.
How the Lp(a) study compared ages
The data came from the Copenhagen General Population Study, which included 57 899 women and 45 442 men aged 20 to 100 years. Nearly one in five, 18,322 people, were aged 70 or older. Previously, whether the link held in old age was unclear, partly because few studies had enough older participants to tell.
Over a median of 12.5 years, 9,091 people were diagnosed with heart attacks, strokes or related disease. The researchers compared risk by Lp(a) level separately in each age band and in women and men.
What happened to heart risk at each age
The proportional risk did not fade with age. The rise in risk per 50 mg/dL higher lipoprotein(a) was similar across all age groups and sexes, meaning each step up in Lp(a) raised risk by roughly 12% to 18%, whether someone was 30 or 85.
In absolute terms, the picture changed completely. The number of extra cases per 1,000 people a year linked to each 50 mg/dL rose from 0.3 in those aged 20 to 49 to 4.5 in those aged 80 to 100. For people with the highest levels, above 90 mg/dL, the extra cases reached 48 per 1,000 people a year in the oldest group. The authors conclude that the risk increase from higher levels was similar for older and younger people, with the highest absolute risk in this older age group.
Why Lp(a) risk after 70 matters
There has been a tendency to see inherited risk factors as a concern for younger people, whose lifetime ahead gives the risk more time to act. This study argues the opposite for Lp(a): it keeps working in old age, and the consequences in raw numbers are greatest there.
That matters for decisions about testing and, eventually, treatment. If drugs now in trials prove able to lower Lp(a) and prevent heart events, older adults with high levels could be among those with the most to gain in absolute terms.
What an observational lipoprotein study cannot show
This is an observational study, and it shows that high Lp(a) travels with more heart disease at every age. It does not show that lowering Lp(a) would prevent those events; that is the question the ongoing drug trials are designed to answer.
Participants all came from one Danish city, and Lp(a) levels and their effects differ between ethnic groups, so the exact figures may not transfer everywhere. Lp(a) was measured once, which is usually reasonable because the level is largely fixed by genes, but not perfectly so.
What this changes for heart risk testing
For people who have never had their Lp(a) measured, the study adds another reason to ask about it, including later in life. Because the level is mostly inherited, a single test in adulthood tells most people what they need to know.
For anyone with high Lp(a), the practical focus today is on the risk factors that can be changed, such as LDL cholesterol, blood pressure and smoking, since those still add to the total risk. Whether a drug aimed at Lp(a) itself will help is a question the next few years of trials should settle.
People also ask
What did the study find?
During a median follow-up of 12.5 years, 9,091 people were diagnosed with atherosclerotic cardiovascular disease. Hazard ratios per 50 mg/dL higher lipoprotein(a) were similar across all age groups and sexes, ranging from 1.12 to 1.18. Absolute incidence increases per 50 mg/dL rose from 0.3 per 1000 person-years at ages 20 to 49 to 4.5 per 1000 person-years at ages 80 to 100.
What is lipoprotein(a)?
A particle in the blood that carries cholesterol, similar to LDL but with an extra protein attached. High levels promote artery plaque and blood clots, and the level is mostly inherited rather than shaped by diet or exercise.
What is atherosclerotic cardiovascular disease?
Heart attacks, strokes and related conditions caused by plaque building up in the arteries.
Why does the absolute risk grow with age if the relative risk stays the same?
Older people have many more heart attacks and strokes to begin with. The same percentage increase on a much higher starting rate adds far more extra cases.
Should I get my Lp(a) tested?
Many heart organizations now suggest testing it at least once in adulthood, because it is largely inherited and not reflected in a standard cholesterol test. Ask your doctor whether it makes sense for you. This is general information rather than medical advice.
Can Lp(a) be lowered?
Lifestyle changes have little effect on it, and there is no approved drug proven to prevent heart events by lowering it. Several are in late-stage trials.