Reclassification of Low or Intermediate Cardiovascular Risk by Determining Lipoprotein(a) Levels

Background: Lipoprotein(a) [Lp(a)] is a modifier of cardiovascular risk, and it should be determined at least once in a lifetime. Methods: Subjects with low or moderate cardiovascular risk, estimated by SCORE2, were invited to have a determination of Lp(a), and those with Lp(a) > 50 mg/dL were classified into a higher-risk category. Eligibility of statins was assessed according to treatment targets. Results: We analyzed 140 subjects, with a mean age of 54.3 (8.1) years and 62.9% women. The median Lp(a) was 15.2 (interquartile range: 6.7-44.5) mg/dL, and 22.1% of the cohort had Lp(a) > 50 mg/dL. No differences were observed in mean age, sex, or lipid profile in subjects with Lp(a) below or above 50 mg/dL; alkaline phosphatase (ALP) was significantly higher in subjects with Lp(a) > 50 mg/dL. After incorporating Lp(a) values into the SCORE-2 assessment, 22.6% of individuals initially of low risk were reclassified as moderate risk, and 77.4% were reclassified from moderate to high risk; moreover, 61.4% (86 subjects) were considered eligible for treatment with statins. Conclusions: Our results highlight that 22.1% of the subjects classified as low or moderate cardiovascular risk by SCORE-2 are reclassified to higher risk, and 61.4% were eligible for statin treatment as a result of Lp(a) testing.