{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T04:46:18Z","timestamp":1776919578733,"version":"3.51.2"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Lipoprotein(a) [Lp(a)] is an established, genetically determined risk factor for atherosclerotic cardiovascular disease (ASCVD), but population-specific thresholds for cardiovascular risk remain uncertain. Data from Central Asia are particularly limited. We aimed to evaluate the relationship between Lp(a) concentrations and coronary artery disease (CAD) severity in a Kazakhstani cohort and to determine an Lp(a) threshold associated with obstructive coronary disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this single-center observational study, 238 adults (mean age 65.1\u202f\u00b1\u202f0.6\u202fyears; 60% male) referred for elective coronary angiography were enrolled. Fasting venous blood samples were obtained for a full lipid panel and Lp(a) assessment. Lp(a) levels were quantified in nmol\/L using an immunoturbidimetric method. CAD severity was categorized as no significant stenosis, 1-vessel, 2-vessel, or \u22653-vessel disease. Between-group comparisons were performed using t-tests and ANOVA. Receiver operating characteristic (ROC) analysis identified an optimal Lp(a) cut-off for predicting significant CAD (\u226550% stenosis in \u22651 vessel), with the Youden index determining the threshold.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Significant CAD was present in 185 patients (78%), while 53 (22%) had no obstructive disease. Lp(a) levels increased stepwise with CAD severity: 36.5\u202f\u00b1\u202f9.4\u202fnmol\/L (no stenosis), 45.3\u202f\u00b1\u202f9.0\u202fnmol\/L (1-vessel), 76.7\u202f\u00b1\u202f14.6\u202fnmol\/L (2-vessel), and 97.2\u202f\u00b1\u202f15.8\u202fnmol\/L (\u22653-vessel disease) (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05 for trend). Patients with prior myocardial infarction had significantly higher Lp(a) than those without (78.9\u202f\u00b1\u202f11.9 vs. 51.9\u202f\u00b1\u202f6.6\u202fnmol\/L,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.04), whereas traditional lipid parameters did not differ by MI status or CAD extent. ROC analysis identified 37\u202fnmol\/L as the optimal threshold for predicting obstructive CAD. Patients with Lp(a)\u202f\u2265\u202f37\u202fnmol\/L had markedly higher odds of significant stenosis (90% vs. 71%, OR 3.4, 95% CI 1.6\u20137.6,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this Kazakhstani cohort, Lp(a) was strongly associated with both the presence and angiographic severity of coronary atherosclerosis, whereas LDL-C and other lipid parameters showed no such relationship. Clinically meaningful risk occurred at substantially lower Lp(a) levels than commonly used Western thresholds. These findings highlight the need for population-specific Lp(a) cut-offs in Central Asia and support routine Lp(a) measurement to improve cardiovascular risk stratification. Larger studies are warranted to refine regional thresholds and assess the value of emerging Lp(a)-lowering therapies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1749546","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T04:20:50Z","timestamp":1776918050000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Population specific risk thresholds for lipoprotein(a): implications from angiographic data in Central Asia"],"prefix":"10.3389","volume":"13","author":[{"given":"Aisulu","family":"Mussagaliyeva","sequence":"first","affiliation":[{"name":"JSC \u201cResearch Institute of Cardiology and Internal Diseases\u201d","place":["Almaty, Kazakhstan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rustem","family":"Tuleutayev","sequence":"additional","affiliation":[{"name":"JSC \u201cResearch Institute of Cardiology and Internal Diseases\u201d","place":["Almaty, Kazakhstan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sholpan","family":"Zhangelova","sequence":"additional","affiliation":[{"name":"Department of Internal Disease, Asfendiyarov Kazakh National Medical University","place":["Almaty, Kazakhstan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dina","family":"Kapsultanova","sequence":"additional","affiliation":[{"name":"Department of Internal Disease, Asfendiyarov Kazakh National Medical University","place":["Almaty, Kazakhstan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dana","family":"Akhmentayeva","sequence":"additional","affiliation":[{"name":"Department of Internal Disease, Asfendiyarov Kazakh National Medical University","place":["Almaty, Kazakhstan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aruzhan","family":"Zhanuzak","sequence":"additional","affiliation":[{"name":"JSC \u201cResearch Institute of Cardiology and Internal Diseases\u201d","place":["Almaty, Kazakhstan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saltanat","family":"Altybayeva","sequence":"additional","affiliation":[{"name":"JSC \u201cResearch Institute of Cardiology and Internal Diseases\u201d","place":["Almaty, Kazakhstan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amina","family":"Rakisheva","sequence":"additional","affiliation":[{"name":"Qonaev City Hospital","place":["Almaty, Kazakhstan"]},{"name":"International Medical School of the UIB","place":["Almaty, Kazakhstan"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,23]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.ejim.2023.10.013","article-title":"Residual cardiovascular risk: when should we treat it?","volume":"120","author":"Gomez-Delgado","year":"2024","journal-title":"Eur J Intern Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"3925","DOI":"10.1093\/eurheartj\/ehac361","article-title":"Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European atherosclerosis society consensus statement","volume":"43","author":"Kronenberg","year":"2022","journal-title":"Eur Heart J"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1953","DOI":"10.1194\/jlr.R071233","article-title":"Lipoprotein (a) as a cause of cardiovascular disease: insights from epidemiology, genetics, and biology","volume":"57","author":"Nordestgaard","year":"2016","journal-title":"J Lipid Res"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1161\/ATVBAHA.119.312951","article-title":"Lipoprotein(a)-lowering by 50 mg\/dL (105 nmol\/L) may be needed to reduce cardiovascular disease 20% in secondary prevention: a population-based study","volume":"40","author":"Madsen","year":"2020","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"54","DOI":"10.1016\/j.pcad.2024.08.004","article-title":"The prevalence, patients' characteristics, and hyper-Lp(a)-emia risk factors in the polish population. The first results from the PMMHRI-Lp(a) registry","volume":"86","author":"Sosnowska","year":"2024","journal-title":"Prog Cardiovasc Dis"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e002060","DOI":"10.1136\/openhrt-2022-002060","article-title":"Lipoprotein(a) levels in a global population with established atherosclerotic cardiovascular disease","volume":"9","author":"Nissen","year":"2022","journal-title":"Open Heart"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1016\/j.jacc.2023.10.039","article-title":"Lipoprotein(a) is markedly more atherogenic than LDL: an apolipoprotein B-based genetic analysis","volume":"83","author":"Bj\u00f6rnson","year":"2024","journal-title":"J Am Coll Cardiol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1161\/ATVBAHA.120.315291","article-title":"Lp(a) (lipoprotein[a]) concentrations and incident atherosclerotic cardiovascular disease: new insights from a large national biobank","volume":"41","author":"Patel","year":"2021","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1991","DOI":"10.1093\/eurjpc\/zwaa063","article-title":"Lipoprotein(a) and cardiovascular disease: prediction, attributable risk fraction, and estimating benefits from novel interventions","volume":"28","author":"Welsh","year":"2022","journal-title":"Eur J Prev Cardiol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e77","DOI":"10.1016\/j.jacl.2022.08.007","article-title":"Use of lipoprotein(a) in clinical practice: a biomarker whose time has come. A scientific statement from the National Lipid Association","volume":"16","author":"Wilson","year":"2022","journal-title":"J Clin Lipidol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1016\/j.jacasi.2022.08.015","article-title":"Lipoprotein(a) and cardiovascular disease in Chinese population: a Beijing heart society expert scientific statement","volume":"2","author":"Li","year":"2022","journal-title":"JACC Asia"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1468566","DOI":"10.3389\/fcvm.2024.1468566","article-title":"Proposing new lipoprotein (a) cut off value for Kazakhstan: pilot study","volume":"11","author":"Bekbossynova","year":"2024","journal-title":"Front Cardiovasc Med"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"6336","DOI":"10.3390\/jcm14176336","article-title":"Ethnic variation in lipoprotein(a) levels in the Kazakhstan population","volume":"14","author":"Bekbossynova","year":"2025","journal-title":"J Clin Med"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"312","DOI":"10.1161\/CIRCULATIONAHA.124.069556","article-title":"Independence of lipoprotein(a) and low-density lipoprotein cholesterol-mediated cardiovascular risk: a participant-level Meta-analysis","volume":"151","author":"Bhatia","year":"2025","journal-title":"Circulation"},{"key":"ref15","first-page":"26","volume-title":"The state of Lipoprotein(a) in Patients with Ischemic Heart Disease of Kazakh Nationality\/ Almaty","author":"Telemtaeva","year":"1998"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1111\/j.1365-2796.2012.02592.x","article-title":"Lipoprotein(a): resurrected by genetics","volume":"273","author":"Kronenberg","year":"2013","journal-title":"J Intern Med"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"856","DOI":"10.1093\/eurjpc\/zwae007","article-title":"Impact of elevated lipoprotein(a) on coronary artery disease phenotype and severity","volume":"31","author":"Leistner","year":"2024","journal-title":"Eur J Prev Cardiol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1172\/JCI115855","article-title":"Apolipoprotein(a) gene accounts for greater than 90% of the variation in plasma lipoprotein(a) concentrations","volume":"90","author":"Boerwinkle","year":"1992","journal-title":"J Clin Invest"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1016\/j.atherosclerosis.2022.04.005","article-title":"Lipoprotein(a) and ethnicities","volume":"349","author":"Mehta","year":"2022","journal-title":"Atherosclerosis"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1172\/JCI113093","article-title":"Lp(a) glycoprotein phenotypes. Inheritance and relation to Lp(a)-lipoprotein concentrations in plasma","volume":"80","author":"Utermann","year":"1987","journal-title":"J Clin Invest"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1711","DOI":"10.1161\/CIRCULATIONAHA.108.836940","article-title":"Relationship of oxidized phospholipids on apolipoprotein B-100 particles to race\/ethnicity, apolipoprotein(a) isoform size, and cardiovascular risk factors: results from the Dallas heart study","volume":"119","author":"Tsimikas","year":"2009","journal-title":"Circulation"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1749546\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T04:20:51Z","timestamp":1776918051000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1749546\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,23]]},"references-count":21,"alternative-id":["10.3389\/fmed.2026.1749546"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1749546","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,23]]},"article-number":"1749546"}}