Available online 10 September 2025, 120516

Elevated baseline Lp(a) is significantly associated with recurrent events post-ACS.

Māori have lower Lp(a) levels than Indian and European participants but a higher risk of adverse outcomes.

Lp(a) above the median is linked to higher risk of death or cardiovascular readmission over 4.9 years.

Lipoprotein(a) (Lp[a]) is an established predictor of cardiovascular risk but associations with secondary events are less certain, and data on understudied ethnic groups are scarce. This study aimed to assess the association between Lp(a) and secondary events and explore variation in Lp(a) levels by ethnicity in first-time acute coronary syndrome (ACS) patients, to inform future risk prediction models.

The Multi-Ethnic New Zealand Study of Acute Coronary Syndromes (MENZACS) is a longitudinal multi-centre cohort study of 1900 patients enrolled during their ACS admission. Baseline plasma Lp(a) concentrations were measured using an isoform-insensitive assay measured in nmol/L. The primary outcome was a composite of all-cause mortality or cardiovascular readmission, ascertained through national health datasets. Cox regression models were used to assess the association between Lp(a) levels and outcomes, adjusted for clinical risk factors.

The mean age was 61 years, 20% were female, and 73% were European, 14% Māori, 5% Pacific peoples, 4% Indian and 3% other ethnicities. Of 1890 alive at discharge, 493 (26%) experienced the primary outcome over a median follow-up of 4.9 years. Higher Lp(a) levels were associated with increased risk of secondary events. Compared to the lowest quartile (≤7nmol/L), the adjusted hazard ratio for the highest quartile (>92nmol/L) was 1.46 (95%CI 1.12–1.89,p=0.004). In this ACS cohort, Lp(a) concentrations varied by ethnicity, being highest amongst Indian participants (median 27 nmol/L) and lowest amongst Māori participants (median 12nmol/L).

Elevated Lp(a) concentrations are associated with secondary events following ACS. Further research is needed to define optimal thresholds for increased risk and explore ethnic-specific implications for secondary prevention.

Lipoprotein(a)

acute coronary syndrome

secondary prevention

ethnicity

© 2025 The Authors. Published by Elsevier B.V.