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Apolipoprotein(a): What Role in Atrial Fibrillation?

Is elevated Lp(a) a risk factor for ischemic stroke in persons with atrial fibrillation? Results of this ARIC analysis explain.

Studies suggest lipoprotein(a) (Lp[a]) is both proatherosclerotic and prothrombotic; elevated plasma levels of Lp(a) have been linked to increased risk for coronary heart disease and stroke. Lp(A) is also associated with atherosclerotic cardiovascular disease which, in turn, is linked with atrial fibrillation (AF). Lp(a) levels are about three times higher in blacks vs whites and 15% to 20% higher in women vs men--but the incidence of AF in blacks and women is lower. The slides that follow highlight a recent study designed to address the question: What is the link between Lp(a) and the development of AF?





Atherosclerosis Risk in Communities. Lp(a) levels were measured in participants of the ARIC study in order to compare incident AF and ischemic stroke across Lp(a) levels.




High Lp(a) Not Linked to New AF. Lp(a) was not linked to incidence AF and results were not affected by race or sex.





High Lp(a) Linked to Ischemic Stroke in Patients without AF. Elevated Lp(a) was not linked to increased ischemic stroke risk in patients with prevalent AF and there was no  increased risk of stroke in patients with intermediate Lp(a) levels.




Clinical Implications. High Lp(a) does not appear to be a risk factor for AF. Study authors propose that the link between high Lp(a) and ischemic stroke may be driven by atherosclerotic rather than cardioembolic stroke.


Take Home Points. Analysis of ARIC study showed that high Lp(a) is not linked to the development of atrial fibrillation;it was found to be linked to increased risk for ischemic stroke in patients without AF, but not in patients with AF. The link between Lp(a) and ischemic stroke may be driven by atherosclerotic disease, not cardioembolism. Results were not affected by race or sex.