Background It is unclear whether
lipoprotein(a) is associated with
coronary heart disease (CHD) and
ischemic stroke events in White and Black adults with atherosclerotic
cardiovascular disease (ASCVD). Methods and Results We conducted a case-cohort analysis, including Black and White REGARDS (Reasons for Geographic and Racial Differences in
Stroke) study participants ≥45 years of age with prevalent ASCVD (ie, CHD or
stroke) at baseline between 2003 and 2007. Baseline
lipoprotein(a) molar concentration was measured in participants with ASCVD who experienced a CHD event by December 2017 (n=1166) or an
ischemic stroke by September 2019 (n=492) and in a random subcohort of participants with prevalent ASCVD (n=1948). The hazard ratio (HR) for CHD events per 1 SD (1.5 units) higher log-transformed
lipoprotein(a) was 1.26 (95% CI, 1.02-1.56) among Black participants and 1.16 (95% CI, 1.02-1.31) among White participants (P value comparing HRs, 0.485). The HR for CHD events per 1 SD higher log-
lipoprotein(a) within subgroups with
hs-CRP (
high-sensitivity C-reactive protein) ≥2 and <2 mg/L was 1.31 (95% CI, 0.99-1.73) and 1.23 (95% CI, 0.85-1.80), respectively (P value comparing HRs, 0.836), among Black participants, and 1.07 (95% CI, 0.91-1.27) and 1.36 (95% CI, 1.10-1.70), respectively (P value comparing HRs, 0.088), among White participants. There was no evidence that the association between
lipoprotein(a) and CHD events differed by
statin use. There was no evidence of an association between
lipoprotein(a) and
ischemic stroke events among Black or White participants. Conclusions Higher
lipoprotein(a) levels were associated with an increased risk for CHD events in Black and White adults with ASCVD.