Elevated lipoprotein(a) is present in approximately one in five individuals and is an established risk factor for atherosclerotic cardiovascular disease (ASCVD). Current pharmacologic treatment indications for overweight (BMI 27–30 kg/m²) require additional risk factors, yet lipoprotein(a) is not included in these criteria. This prospective cohort study published in the European Journal of Preventive Cardiology evaluated whether high lipoprotein(a) and body mass index (BMI) jointly confer increased ASCVD risk.

The analysis included 512,687 women and men without ASCVD and 14,161 with ASCVD from the Copenhagen General Population Study and the UK Biobank. During follow-up, 39,255 and 3,501 ASCVD events occurred in primary and secondary prevention populations, respectively.

In primary prevention, individuals with lipoprotein(a) in the 95th–100th percentile and BMI >30 kg/m² had hazard ratios for ASCVD of 1.97 (95% CI 1.61–2.40) in the Copenhagen cohort and 2.19 (95% CI 2.01–2.37) in the UK Biobank, compared with lipoprotein(a) in the 1st–49th percentile and BMI 18.5–26.9 kg/m². Absolute 10-year risks at ages 70–79 reached 25% in women and 41% in men with lipoprotein(a) 95th–100th percentile and BMI 27–30 kg/m², versus 17% and 28% with low lipoprotein(a) and BMI >30 kg/m². In secondary prevention, overall patterns were similar, with higher risk observed among individuals with high lipoprotein(a) even at BMI 18.5–26.9 kg/m² compared with BMI ≥27 kg/m² and low lipoprotein(a).

High lipoprotein(a) and elevated BMI were associated with the highest ASCVD risk. Risk patterns were consistent across primary and secondary prevention settings.