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Impact of Lipoprotein A on Long-Term Outcomes in Acute Coronary Syndrome: A Retrospective Cohort Analysis
Session:
SESSÃO DE COMUNICAÇÕES ORAIS 07 - PRÉMIO FERRER MELHOR COMUNICAÇÃO ORAL EM PREVENÇÃO SECUNDÁRIA
Speaker:
Cátia Oliveira
Congress:
CPC 2025
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.3 Secondary Prevention
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Cátia Oliveira; Ana Pinho; Catarina Marques; Luís Santos; André Cabrita; Helena Moreira; Pedro Palma; Miguel Rocha; Bernardo Cruz; Emanuel Oliveira; Joana Gonçalves; Rui André Rodrigues
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Introduction:</strong><br /> Lipoprotein(a) [Lp(a)] has emerged as an important cardiovascular risk factor (CVRF). Higher Lp(a) levels (>50 mg/dL) have been linked to increased CV risk, but the exact cut-off and its impact on outcomes remain unclear. This study aimed to examine the effect of high Lp(a) on post-acute coronary syndrome (ACS) complications and outcomes during follow-up.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Methods:</strong><br /> This retrospective cohort study included 225 patients (pts) admitted with ACS between January 2020 and October 2023 at a tertiary care center. Lp(a) levels were measured on admission, and the analysis focused on pts with Lp(a) >50 mg/dL. Data was obtained from medical records, and follow-up outcomes were assessed.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Results:</strong><br /> The cohort had a mean age of 56.8 years, with 18.7% women and a high prevalence of CVRF (96%). Of the patients, 48% had non-ST-segment elevation ACS and 52% had ST-segment elevation ACS. The median follow-up was 26 months, with a median Lp(a) level of 36.6 mg/dL.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Among the 87 pts with Lp(a) >50 mg/dL, no significant differences were observed in baseline characteristics compared to Lp(a)<50 mg/dL pts, especially regarding LDL-c levels at admission (p=0.6), except for a higher prevalence of family history of premature coronary heart disease (CHD) (p=0.04). Patients with higher Lp(a) were more likely to be on dyslipidemia medications prior to the index event (p=0.02) and were more often prescribed higher-intensity regimens (p<0.001).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">In terms of in-hospital outcomes, both groups were comparable regarding coronary angiography (p=0.3), revascularization (p=0.7), Killip classification (p=0.3), left ventricular dysfunction (p=0.1), and immediate post-ACS complications (p=0.9). However, pts with elevated Lp(a) showed more complex coronary disease, with higher rates of multivessel involvement (p<0.01).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">During long-term follow-up, the high Lp(a) group had a significantly higher rate of CV events (log-rank p=0.03), with a mean time-to first-CV-event of 23.5 months. A total of 10.7% of the cohort experienced a CV event, including a new ACS episode (5.3%) and heart failure hospitalization (4.1%). All-cause mortality was 5.4%, with 3.2% attributed to cardiovascular death.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusion:</strong><br /> In this cohort of ACS patients, elevated Lp(a) levels (>50 mg/dL) were associated with worse long-term CV outcomes, despite similar baseline characteristics, including lipid levels at admission. Additionally, elevated Lp(a) was linked to a higher incidence of a family history of premature CHD, suggesting a genetic predisposition. These findings highlight the importance of Lp(a) in identifying high-risk ACS patients who may require closer monitoring and more aggressive CV risk management. Further studies are needed to confirm these results and explore therapeutic strategies for managing elevated Lp(a) in this high-risk subgroup.</span></span></p>
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