The International INTERASPIRE Study maps the prevalence of Lipoprotein (a) in Coronary Heart Disease Patients across all six WHO regions
InterAspire, a groundbreaking international study examining secondary prevention of coronary heart disease (CHD) has shed light on the prevalence and implications of elevated Lipoprotein(a) levels, also called Lp(a), among newly diagnosed CHD patients. Conducted between 2020 and 2023, the study Included over 4,500 participants across 14 countries spanning six WHO regions. Lp(a) was measured in a central laboratory for 13 of these countries: Argentina, China, Colombia, Indonesia, Kenya, Malaysia, Nigeria, Philippines, Poland, Portugal, Singapore, Tanzania, and UAE. Lp(a) was not measured in Egypt.
The study focused on adults who were hospitalised due to an incident or a recurrent CHD event, with follow-up approximately one year after their initial hospitalisation. Participants underwent standardised interviews and examinations, including blood sampling. All blood variables were analysed at the THL laboratory in Helsinki, Finland, where plasma, serum, and whole blood samples are stored long-term. All statistical analyses were standardised for age and sex.
Key findings from the INTERASPIRE Lp(a) study were presented by Professor Kausik K Ray, from Imperial College London, during a late-breaking scientific session at the European Society of Cardiology (ESC) Congress in London, UK, on September 1, 2024.
Key Findings:
The study measured Lp(a) levels in 3,928 CHD patients (21.1% women) with a mean age of 60.2 ± 10 years. The median Lp(a) level was 32 nmol/L (IQR: 11-89).
- The prevalence of Lp(a) ≥ 115 nmol/L was 19.6%, with significant variability by region and country.
- Prevalences at key ASCVD risk trial thresholds were: 13.0% at 150 nmol/L (HORIZON), 9.3% at 175 nmol/L (ACCLAIM), and 6.2% at 200 nmol/L (OCEAN).
- Higher Lp(a) levels were observed in women, patients with chronic kidney disease, those with peripheral arterial disease, and in patients prescribed PCSK9 inhibitors.
Among patients with Lp(a) ≥ 115 nmol/L, only 1.8% achieved a completely healthy lifestyle. Breakdown of lifestyle and health metrics includes:
- 86.1% were non-smokers or ex-smokers (validated by breath CO < 10 ppm).
- 66.7% had blood pressure < 140/90 mmHg.
- 53.4% maintained HbA1c < 6.5% and fasting glucose (FG) < 5.5 mmol/L (for diabetic patients: HbA1c < 7.0% and FG < 7.0 mmol/L).
- 39.5% engaged in regular physical activity (≥ 30 minutes, 5 times per week).
- 32.0% had a BMI < 25 kg/m².
- 29.4% achieved LDL-C < 1.8 mmol/L.
As trials investigating Lp(a) reduction continue, it is crucial to address unhealthy lifestyles and inadequately controlled risk factors among CHD patients with elevated Lp(a).
“We must address these discrepancies in care to ensure equitable access to secondary prevention strategies for all patients,” said Professor David Wood, Director of Science, Strategy and International Relations at the National Institute for Prevention and Cardiovascular Health (NIPC) and Adjunct Professor of Preventive Cardiology at University of Galway, Ireland. “The INTERASPIRE study underscores the critical need for investment in healthcare systems to reduce variability and improve outcomes for patients with coronary heart disease globally.”
The INTERASPIRE study calls for unified efforts among healthcare providers, policymakers, and researchers to promote effective secondary prevention services and reduce the global burden of coronary heart disease.
See full presentation here: INTERASPIRE – A Global Perspective of Lp(a) Levels
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