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Lipoprotein A and Cardiovascular Risk in Acute Myocardial Infarction: What Have We Learned in 5 Years?
Session:
SESSÃO DE POSTERS 07 - DOENÇAS CARDIOVASCULARES - LESÃO RENAL AGUDA E INFLAMAÇÃO
Speaker:
Cátia Oliveira
Congress:
CPC 2025
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.5 Acute Coronary Syndromes – Prevention
Session Type:
Cartazes
FP Number:
---
Authors:
Cátia Oliveira; Ana Pinho; Catarina Marques; Luís Santos; Miguel Rocha; Helena Moreira; Pedro Palma; Bernardo Cruz; Emanuel Oliveira; Joana Gonçalves; Paulo Araújo; Rui André Rodrigues
Abstract
<p><strong>Background</strong>: Lipoprotein(a) [Lp(a)] has emerged as a potential independent marker of cardiovascular risk, particularly in pts with atherosclerotic cardiovascular disease. However, its clinical utility, especially in the context of acute coronary syndrome (ACS), remains underexplored. This study aims to assess Lp(a) levels in ACS pts and evaluate their association with clinical outcomes and lipid management.</p> <p><strong>Methods</strong>: This retrospective study analyzed pts admitted with acute coronary syndrome (ACS) at a tertiary care center between 2020 and 2023, with Lp(a) testing performed at admission. Baseline characteristics, clinical outcomes, lipid management, and treatment regimens were reviewed.</p> <p><strong>Results</strong>: A total of 225 pts were included, with a median age of 56.8 years and a median follow-up of 26 months. The cohort included 18.6% females, and 96% had ≥1 cardiovascular risk factor (CVRF). 56.9% of pts had Lp(a) ≥ 30 mg/dL, with a median Lp(a) of 36.6 mg/dL.</p> <p>Testing frequency of Lp(a) improved over time, though less than half of ACS pts were tested in the final year of the study (Figure 1). No significant differences were observed in Lp(a) levels concerning sex, age, CVRF, family history of premature coronary heart disease, or previous cv events. Notably, higher Lp(a) levels were associated with increased use of pre-AMI antidyslipidemic treatments (p < 0.01) and higher-intensity lipid-lowering regimens (p < 0.01).</p> <p>In-hospital outcomes showed no significant differences except for a higher incidence of multivessel coronary disease in pts with elevated Lp(a) (p = 0.02). During follow-up, pts with higher Lp(a) levels experienced worse cardiovascular outcomes, including increased CV death and CV-related hospitalizations (median Lp(a) of 65.9 mg/dL vs. 34.8 mg/dL; p = 0.028). The incidence of recurrent ACS and heart failure hospitalization was 5.4% and 4.1%, respectively.</p> <p>Higher Lp(a) levels were also associated with worse lipid control during follow-up, with more pts failing to achieve LDL-C targets (median Lp(a) of 48.3 mg/dL vs. 26.1 mg/dL in LDL-targeted pts, p < 0.01). Genetic testing for familial hypercholesterolemia was performed in 5.8% of the cohort and was more common in pts with higher Lp(a) (median Lp(a) of 96.7 mg/dL vs. 34.9 mg/dL, p = 0.009).</p> <p><strong>Conclusion</strong>: Our study highlights the growing recognition of Lp(a) as a CV risk marker in ACS patients. Despite improvements in testing, Lp(a) remains underutilized in clinical practice. Elevated Lp(a) levels were associated with worse lipid control and worse CV outcomes, even with high-intensity lipid-lowering therapy. Genetic testing, while more common in pts with elevated Lp(a), remains insufficient. These findings emphasize the need for improved assessment and personalized management of pts with high Lp(a) levels. Larger studies with longer follow-up are needed to develop targeted therapeutic strategies for this high-risk group.</p>
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