The study examined the prognostic value of simultaneous measurement of lipoprotein(a) (Lp(a)) and high-sensitivity C-reactive protein (hsCRP) levels in primary prevention in individuals without traditional modifiable risk factors (no hypertension, diabetes, dyslipidemia, or smoking).
The UK Biobank cohort included 50,144 adult participants without prior cardiovascular events.
Over 15 years of follow-up, 1104 (2.2%) incident ASCVD events occurred. Using cohort-specific cutoffs, elevated hsCRP was associated with higher ASCVD risk (sHR 1.35, 95% CI 1.16–1.57), while elevated Lp(a) showed a more modest association (sHR 1.24, 95% CI 1.06–1.45). In joint analyses, isolated elevations of hsCRP or Lp(a) were each associated with increased risk, with the highest risk observed among individuals with concurrent elevations (sHR 1.64, 95% CI 1.28–2.09), without evidence of interaction. Similar patterns were observed using clinical cutoffs [Lp(a) ≥ 125 nmol/L; hsCRP ≥2.0 mg/L], with concurrent elevation conferring the greatest risk (sHR 1.74, 95% CI 1.17–2.59).
The authors concluded that Lp(a) and hsCRP independently predict the development of vascular events in individuals formally classified as low-risk according to standard scales, and their combined measurement significantly improves the accuracy of individual stratification in primary prevention.
European Journal of Preventive Cardiology, 2026, zwag221, https://doi.org/10.1093/eurjpc/zwag221
