Lipoprotein(a) screening in young and middle-aged patients presenting with acute coronary syndrome
Ayman Jubran1, Anna Zetser2, Barak Zafrir3
1Department of Cardiology, Lady Davis Carmel Medical Center, Haifa, Israel, Haifa, Israel.
Insights
Elevated lipoprotein(a) [Lp(a)] is linked to premature coronary artery disease (CAD) and familial hypercholesterolemia (FH) in acute coronary syndrome (ACS) patients. This highlights the importance of Lp(a) screening for managing cardiovascular risk.
Area of Science:
- Cardiology
- Clinical Chemistry
- Genetics
Background:
- Elevated lipoprotein(a) [Lp(a)] is a known independent risk factor for coronary artery disease (CAD).
- The clinical implications and real-world practice of managing Lp(a) levels remain underexplored.
- This study investigates clinical characteristics associated with elevated Lp(a) in patients experiencing acute coronary syndrome (ACS).
Purpose of the Study:
- To identify clinical factors associated with elevated lipoprotein(a) [Lp(a)] in patients with acute coronary syndrome (ACS).
- To understand the role of Lp(a) in younger and middle-aged ACS patients.
- To inform clinical practice and risk stratification strategies for cardiovascular disease.
Main Methods:
- Lipoprotein(a) [Lp(a)] levels were measured in 134 patients aged ≤ 65 presenting with ACS.
- Logistic regression analysis was employed to determine independent associations between clinical characteristics and elevated Lp(a).
Main Results:
- 32% of patients had elevated Lp(a) (> 72 nmol/L).
- Elevated Lp(a) was independently associated with premature CAD (OR 3.85), previous revascularization (OR 2.56), and familial hypercholesterolemia (FH) (OR 3.18).
- No association was found between Lp(a) levels and traditional cardiovascular risk factors, statin use, or C-reactive protein levels.
Conclusions:
- In younger ACS patients, premature CAD, prior revascularization, and FH are linked to elevated Lp(a), suggesting progressive disease and heightened risk.
- These findings support current guidelines recommending Lp(a) screening.
- Identifying elevated Lp(a) is crucial for managing residual cardiovascular risk, especially with emerging Lp(a)-targeting therapies.
Background:
Elevated lipoprotein(a) [Lp(a)] is an independent risk factor for coronary artery disease (CAD). However, its role in real-world practice and implications for clinical care remains limited. Under investigation herein, are the clinical characteristics associated with increased Lp(a) levels in patients presenting with acute coronary syndrome (ACS).
Methods:
Lp(a) was measured at admission in patients ≤ 65 years of age presenting with ACS in a single center. Logistic regression model was used to determine the independent association of clinical characteristics with elevated Lp(a).
Results:
A total of 134 patients were screened for Lp(a); 83% males, mean age 52 ± 8 years. Median Lp(a) level was 46 nmol/L (interquartile range [IQR] 13-91). Elevated Lp(a) > 72 nmol/L (30 mg/dL) was documented in 32% and associated with younger age at CAD diagnosis. In a multiple logistic regression model, premature CAD (odds ratio [OR] 3.85, 95% confidence interval [CI] 1.48-10.07, p = 0.06), previous revascularization (OR 2.56, 95% CI 1.17-5.59, p = 0.019) and probable/definite familial hypercholesterolemia (FH) (OR 3.18, 95% CI 1.10-9.21, p = 0.033), were independently associated with elevated Lp(a). In contrast, Lp(a) levels were not associated with other traditional cardiovascular risk factors, previous statin treatment, C-reactive protein level or ACS type.
Conclusions:
In young and middle-aged patients presenting with ACS, premature CAD, previous revascularization and FH were independently associated with elevated Lp(a), indicating progressive CAD and higher cardiovascular risk. These results, are in accordance with guideline based recommendations for Lp(a) screening, and may be of importance in addressing residual cardiovascular risk in young ACS patients, in light of the novel emerging therapies targeting Lp(a).
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