LIPID METABOLISM: Edited by Henry GinsbergLipoprotein(a): is it more, less or equal to LDL as a causal factor for cardiovascular disease and mortality?Langsted, Annea,b,c; Nordestgaard, Børge G.a,b,cAuthor Information aDepartment of Clinical Biochemistry bThe Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital cFaculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Correspondence to Anne Langsted, MD, PhD, Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 73, Opgang 7, 4.etage, N5, DK-2730 Herlev, Denmark. Tel: +45 3868 9869; e-mail: email@example.com Current Opinion in Lipidology: June 2020 - Volume 31 - Issue 3 - p 125-131 doi: 10.1097/MOL.0000000000000681 Buy Metrics Abstract Purpose of review To summarize the recent studies directly comparing LDL and lipoprotein(a) as causal factors for cardiovascular disease and mortality. Recent findings In approximately 100,000 individuals from the Copenhagen General Population Study for risk of myocardial infarction, in observational analyses per 39 mg/dl (1 mmol/l) cholesterol increase, the hazard ratio was 1.3 (95% confidence interval: 1.2–1.3) for LDL cholesterol and 1.6 (1.4–1.9) for lipoprotein(a) cholesterol. In corresponding genetic analyses, the causal risk ratio was 2.1 (1.3–3.4) for LDL and 2.0 (1.6–2.6) for lipoprotein(a). Also, a 15 mg/dl (0.39 mmol/l) cholesterol increase was associated with a hazard ratio for cardiovascular mortality of 1.05 (1.04–1.07) for LDL cholesterol and 1.18 (1.12–1.25) for lipoprotein(a) cholesterol. Corresponding values for all-cause mortality were 1.01 (1.00–1.01) for LDL cholesterol and 1.07 (1.04–1.10) for lipoprotein(a) cholesterol. In genetic, causal analyses, the mortality increases for elevated lipoprotein(a) appeared to be through apolipoprotein(a) kringle IV-2 rather than through lipoprotein(a) levels per se. Summary On cholesterol scales, lipoprotein(a) and LDL appeared equal as causal factors for myocardial infarction; however, lipoprotein(a) was most important for mortality. Lipoprotein(a) effects may not only be due to cholesterol content but could also be due to the structure of lipoprotein(a) resembling plasminogen. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.