Lipoprotein(a): An underrecognized genetic risk factor for malignant coronary artery disease in young Indians

Enas A. Enas, Basil Varkey, T. S. Dharmarajan, Guillaume Pare, Vinay K. Bahl

Research output: Contribution to journalReview articlepeer-review

32 Scopus citations


Malignant coronary artery disease (CAD) refers to a severe and extensive atherosclerotic process involving multiple coronary arteries in young individuals (aged <45 years in men and <50 years in women) with a low or no burden of established risk factors. Indians, in general, develop acute myocardial infarction (AMI) about 10 years earlier; AMI rates are threefold to fivefold higher in young Indians than in other populations. Although established CAD risk factors have a predictive value, they do not fully account for the excessive burden of CAD in young Indians. Lipoprotein(a) (Lp(a)) is increasingly recognized as the strongest known genetic risk factor for premature CAD, with high levels observed in Indians with malignant CAD. High Lp(a) levels confer a twofold to threefold risk of CAD—a risk similar to that of established risk factors, including diabetes. South Asians have the second highest Lp(a) levels and the highest risk of AMI from the elevated levels, more than double the risk observed in people of European descent. Approximately 25% of Indians and other South Asians have elevated Lp(a) levels (≥50 mg/dl), rendering Lp(a) a risk factor of great importance, similar to or surpassing diabetes. Lp(a) measurement is ready for clinical use and should be an essential part of all CAD research in Indians.

Original languageEnglish (US)
Pages (from-to)184-198
Number of pages15
JournalIndian Heart Journal
Issue number3
StatePublished - May 1 2019


  • ASCVD risk enhancing factor
  • Acute coronary syndrome
  • Acute myocardial infarction
  • Cardiovascular disease
  • Coronary artery disease
  • Indians
  • Lipoprotein(a)
  • Lp(a)-years
  • Malignant coronary artery disease
  • Mendelian randomization
  • Standardized mortality ratio

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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