European Journal of Preventive Cardiology · Feb 23, 2026
High lipoprotein(a) and high BMI jointly confer the highest risk of ASCVD in both primary and secondary prevention
By Thomas PE, Nielsen SF, Nordestgaard BG et al.
AIMS: Novel pharmaceuticals lower body mass index (BMI) and reduce risk of atherosclerotic cardiovascular disease (ASCVD), yet treatment indications for BMI 27-30 kg/m² require additional risk factors. High lipoprotein(a), present in 1 in 5 individuals, is a risk factor for ASCVD not included in overweight treatment guidelines. We hypothesised that high lipoprotein(a) and BMI jointly confer the highest risk of ASCVD. METHODS: Prospective cohort study of 512,687 women and men without and 14,161 with ASCVD from the Copenhagen General Population Study (CGPS) and the UK Biobank. During follow-up, 39,255 and 3,501 developed ASCVD in primary and secondary prevention. RESULTS: In primary prevention, hazard ratios for ASCVD for individuals with high lipoprotein(a) (95th-100th percentile) and BMI>30 were 1.97 (95% CI:1.61-2.40) in the CGPS and 2.19 (2.01-2.37) in the UK Biobank when compared to low lipoprotein(a) (1st-49th percentile) and BMI of 18.5-26.9 kg/m². Absolute risks were higher for concomitant high lipoprotein(a) and BMI 27-30 kg/m² than for BMI>30 kg/m² and low lipoprotein(a), with 10-year absolute risks for ages 70-79 of 25% in women and 41% in men for lipoprotein(a) 95th-100th percentiles and BMI 27-30 kg/m², and correspondingly 17% and 28% for lipoprotein(a) 1st-49th percentiles and BMI>30 kg/m². In secondary prevention, overall results were similar, with higher risks for individuals with high lipoprotein(a) and BMI 18.5-26.9 kg/m², than for BMI≥27 kg/m2 and low lipoprotein(a). CONCLUSION: High lipoprotein(a) and high BMI jointly confer the highest risk of ASCVD in primary and secondary prevention.