ArticleFrontiers in medicine2026
Population specific risk thresholds for lipoprotein(a): implications from angiographic data in Central Asia.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Lipoprotein(a) [Lp(a)] is an established, genetically determined risk factor for atherosclerotic cardiovascular disease (ASCVD), but population-specific thresholds for cardiovascular risk remain uncertain. Data from Central Asia are particularly limited. We aimed to evaluate the relationship between Lp(a) concentrations and coronary artery disease (CAD) severity in a Kazakhstani cohort and to determine an Lp(a) threshold associated with obstructive coronary disease. Methods: In this single-center observational study, 238 adults (mean age 65.1 ± 0.6 years; 60% male) referred for elective coronary angiography were enrolled. Fasting venous blood samples were obtained for a full lipid panel and Lp(a) assessment. Lp(a) levels were quantified in nmol/L using an immunoturbidimetric method. CAD severity was categorized as no significant stenosis, 1-vessel, 2-vessel, or ≥3-vessel disease. Between-group comparisons were performed using t-tests and ANOVA. Receiver operating characteristic (ROC) analysis identified an optimal Lp(a) cut-off for predicting significant CAD (≥50% stenosis in ≥1 vessel), with the Youden index determining the threshold. Results: Significant CAD was present in 185 patients (78%), while 53 (22%) had no obstructive disease. Lp(a) levels increased stepwise with CAD severity: 36.5 ± 9.4 nmol/L (no stenosis), 45.3 ± 9.0 nmol/L (1-vessel), 76.7 ± 14.6 nmol/L (2-vessel), and 97.2 ± 15.8 nmol/L (≥3-vessel disease) ( Conclusion: In this Kazakhstani cohort, Lp(a) was strongly associated with both the presence and angiographic severity of coronary atherosclerosis, whereas LDL-C and other lipid parameters showed no such relationship. Clinically meaningful risk occurred at substantially lower Lp(a) levels than commonly used Western thresholds. These findings highlight the need for population-specific Lp(a) cut-offs in Central Asia and support routine Lp(a) measurement to improve cardiovascular risk stratification. Larger studies are warranted to refine regional thresholds and assess the value of emerging Lp(a)-lowering therapies.
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