Extreme lipoprotein(a) linked with increased risk of cardiovascular disease: Study

Against the above background, Barak Zafrir from the Israel Institute of Medicine, Israel, and colleagues aimed to analyze the clinical features of patients with extreme Lp(a) in a case-control, cross-sectional study of a single healthcare organization between 2015 and 2021.

The study included Individuals with extreme Lp(a) > 430 nmol/L (53 of 3900 tested patients). They were compared to age- and sex-matched controls with a normal Lp(a) range. The mean patient age was 58 ± 14 years (49% women).

The key findings of the study were as follows:

• Myocardial infarction (47.2% vs. 18.9%), coronary artery disease (CAD) (62.3% vs. 28.3%), and peripheral artery disease (PAD) or stroke (22.6% vs. 11.3%) were more prevalent in patients with extreme than normal range Lp(a).
• The adjusted odds ratio associated with extreme compared to normal range Lp(a) was 2.50 for myocardial infarction, 2.20 for CAD, and 2.75 for PAD or stroke.
• A high-intensity statin plus ezetimibe combination was issued by 33% and 20% of CAD patients with extreme and normal range Lp(a), respectively.
• In patients with CAD, low-density lipoprotein cholesterol (LDL-C) <55 mg/dL was achieved in 36% of those with extreme Lp(a) and 47% of those with normal range Lp(a).

"Our findings showed that ASCVD, particularly CAD, was remarkably more prevalent in people with extreme Lp(a) levels compared to matched controls with normal range Lp(a), supporting recent recommendations of Lp(a) measurement once in each person's lifetime," the researchers wrote.

Despite the availability of several therapeutic groups for cholesterol reduction, there is a suboptimal attainment rate of LDL-C treatment goals due to the minimal use of PCSK9 inhibitors and underutilization of combination lipid-lowering therapy, which may impart clinical benefit in those with elevated Lp(a).

Reference:

Zafrir, B., Aker, A., & Saliba, W. (2023). Extreme lipoprotein(a) in clinical practice: A cross sectional study. International Journal of Cardiology Cardiovascular Risk and Prevention, 16, 200173. https://doi.org/10.1016/j.ijcrp.2023.200173