The role of lipoprotein(a) in predicting coronary artery disease among ageing endurance athletes and healthy controls

Abstract

Aims Ageing endurance athletes have a higher prevalence of coronary artery disease (CAD) on coronary computed tomography angiography than healthy controls, despite similarly low conventional cardiovascular (CV) risk. The predictive value of lipoprotein(a) [Lp(a)] for CAD in these low-risk individuals remains unclear. Methods and results The Master@Heart study included 558 men (aged 45-70 years) without known CV risk factors: 191 lifelong athletes, 191 late-onset athletes, and 176 healthy controls. Coronary computed tomography angiography assessed coronary artery calcification (CAC) and plaques. The association between Lp(a) and subclinical CAD was assessed using logistic regression analysis to estimate odds ratios (ORs), adjusted for CV risk factors. Lipoprotein(a) was analysed dichotomously (<125 vs. >125 nmol/L) and continuously (per 10 nmol/L increase). Seventy-six participants (13.6%) had elevated Lp(a) levels (>125 nmol/L). Elevated Lp(a) was significantly associated with age-specific CAC percentile >= 75 (OR 1.80, P = 0.049) and >= 1 mixed plaque (OR 1.76, P = 0.046). Other CAD measures all tended to be more prevalent in those with elevated Lp(a). In the continuous analysis, Lp(a) was significantly associated with CAC > 100 (OR 1.03, P = 0.045), CAC percentile >= 75 (OR 1.04, P = 0.014), and >= 1 mixed or non-calcified plaque (OR 1.03, P = 0.029). Lipoprotein(a) and prevalence of elevated Lp(a) were similar across lifelong athletes, late-onset athletes, and controls (P = 0.586 and P = 0.724, respectively). No significant interaction was found between Lp(a) and the exercise groups in predicting CAD. Conclusion Lipoprotein(a) is independently associated with subclinical CAD in ageing endurance athletes and healthy controls, despite similarly low conventional CV risk. Lipoprotein(a) does not explain the higher CAD prevalence in lifelong athletes compared with controls, but may enhance risk stratification in this low-risk population.