IMR Press / RCM / Volume 22 / Issue 4 / DOI: 10.31083/j.rcm2204162
Open Access Original Research
Relationship between Lipoprotein(a) and cardiovascular risk factors—data from 4602 participants of the ELITE study
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1 Department of Cardiology, University of Oldenburg, 26133 Oldenburg, Germany
2 Institute for Hypertension and Cardiovascular Research (INFO), St.-Josefs-Hospital, 49661 Cloppenburg, Germany
3 Clinic for Renal and Hypertensive Diseases, Hannover Medical School, 30625 Hanover, Germany
4 Department of Nephrology and Rheumatology, University Medical Center Göttingen, 37075 Göttingen, Germany
5 Department of Nephrology, Internal Medicine, St.-Josefs-Hospital, 49661 Cloppenburg, Germany
*Correspondence: (Bastian Schrader)
Academic Editor: Matina Kouvari
Rev. Cardiovasc. Med. 2021, 22(4), 1569–1575;
Submitted: 16 August 2021 | Revised: 6 September 2021 | Accepted: 8 September 2021 | Published: 22 December 2021
(This article belongs to the Special Issue Diet, nutrients and cardiovascular disease prevention)
Copyright: © 2021 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license (

Lipoprotein(a) (Lp(a)) is becoming increasingly important as an independent risk factor for cardiovascular disease. Since no effective therapy currently exists other than lipid apheresis, the recommendation remains to optimally adjust all other cardiovascular risk factors (CVRF). In a Northwest German population study, the frequency of elevated Lp(a) levels and all other CVRF was investigated. The aim was to investigate whether individuals with elevated Lp(a) levels were also more likely to have other CVRFs. To date, 4602 individuals have been enrolled in the study, and blood pressure, weight, lipids, diabetes, medications, and pre-existing conditions were recorded in addition to Lp(a). In addition, questionnaires assessed physical activity, psychological stress, depression, and brain dysfunction. All participants received detailed individual recommendation about their CVRF and its treatment. In the further follow-up of 5 years, it will be examined how persons with elevated Lp(a) implemented these recommendations in comparison with participants without elevated Lp(a). The first group Lp(a) <75 nmol/L consisted of 3550 (80.2%), the Lp(a) 75–120 nmol/L group of 341 (7.4%) and the Lp(a) >120 nmol/L of 538 (11.7%). 81.6% of all participants had one or more CVRF. Age, sex, and prevalence of hypertension, diabetes, smoking, obesity, and exercise did not differ among the 3 groups. As expected, LDL-Cholesterol was significantly elevated in the Lp(a) >120 nmol/L group despite significantly more frequent use of statins. Significantly more often hypertensive patients were found in the Lp(a) >120 nmol/L group who were inadequately controlled by medication and significantly less often persons without further CVRF. No differences existed in the frequency of psychological stress, depression, and mild cognitive impairment. CVRF occur with comparable frequency in individuals with elevated Lp(a) levels. However, individuals with Lp(a) above 120 nmol/L were more likely to have poorly controlled blood pressure, elevated LDL-C, and less likely to have no other risk factors. This underlines that in case of Lp(a) elevation all further CVRF should be intensively adjusted, especially in case of strongly elevated values >120 nmol/L. However, these recommendations have not been adequately implemented in clinical care in this population to date.

Cardiovascular risk factors
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