Combined LDL-C, Lp(a) and HsCRP Assessment Identifies Long-Term Risk of Ascvd

A study of 15,676 HELIUS participants found that combined assessment of LDL-C, Lp(a) and hsCRP identifies individuals at greater long-term risk of atherosclerotic cardiovascular disease (ASCVD), with those having all three elevated biomarkers facing a 2.44-fold increased risk. The findings were consistent across ethnic groups, with highest absolute risk in South Asian Surinamese participants.

Combined LDL-C, Lp a and hsCRP Assessment Identifies Long-Term Risk of ASCVD Combined assessment of LDL-C, Lp a and hsCRP reflected independent pathways for identifying individuals of varied ethnicities at greater long-term risk of atherosclerotic cardiovascular disease ASCVD , according to an analysis of the HELIUS cohort https://www.jacc.org/doi/10.1016/j.jacc.2026.05.006 published June 24 in JACC . Maxim E. Annink, MD, MSc, LLM , et al., included 15,676 HELIUS participants mean age 44 years, 56% women of African, European and South Asian Surinamese descent without prior myocardial infarction or ischemic stroke. Incident ASCVD was determined via nationwide registries over a median follow-up period of 8.9 years. The authors sought to assess the additive and multiplicative interaction of LDL-C, Lp a and hsCRP on ASCVD risk. Overall, 378 ASCVD events occurred throughout the study. Hazard ratios comparing top vs. bottom quintiles for each biomarker were 1.39 for LDL-C, 1.86 for Lp a and 1.51 for hsCRP. No interaction was observed on the multiplicative or additive scale. ASCVD risk increased with the number of elevated biomarkers. Participants with all three elevated biomarkers had a 2.44-fold increase in risk. Patterns were consistent across ethnic groups; however, absolute ASCVD risk was highest among participants of South Asian Surinamese descent. "In HELIUS, individuals with joint elevations of Lp a and hsCRP, neither of which appears in standard clinical risk models, had close to two-fold higher ASCVD risk that those without these elevations," add the authors. "Addition of Lp a and hsCRP to a PREVENT-ASCVD–based clinical model modestly improved discrimination ΔAUC: 0.006 and produced a more pronounced improvement in reclassification NRI: 0.17 at 10 years." In an accompanying editorial comment https://www.jacc.org/doi/10.1016/j.jacc.2026.05.023 , Anurag Mehta, MD, FACC , notes that "the current study does not call for a new risk score, and clinicians should resist the temptation to retrofit one. What it does call for is a pathway-oriented approach to prevention that current guidelines already endorse." Clinical Topics: Dyslipidemia, /Clinical-Topics/Dyslipidemia Advanced Lipid Testing, /Clinical-Topics/Dyslipidemia/Advanced-Lipid-Testing Lipid Metabolism, /Clinical-Topics/Dyslipidemia/Lipid-Metabolism Nonstatins /Clinical-Topics/Dyslipidemia/Nonstatins Keywords: Lipoprotein a , Cholesterol, LDL, C-Reactive Protein, Cardiovascular Diseases, Risk Factors, Biomarkers