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Implications of lipoprotein(a) variability on cardiovascular risk classification enhancement
Session:
Sessão de Posters 07 - Lípidos para além do LDL: a nova fronteira do risco
Speaker:
Marta Catarina Almeida
Congress:
CPC 2026
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.2 Risk Factors and Prevention – Cardiovascular Risk Assessment
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Marta Catarina Ferreira de Almeida; André Lobo; Carolina Marques Neves; Eduardo Vilela; Ricardo Fontes-Carvalho
Abstract
<p style="margin-left:47px; text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Background: </strong>Lipoprotein(a) [Lp(a)] is an independent risk factor for atherosclerotic cardiovascular (CV) disease. Guidelines suggest a one-in-a-lifetime measurement, enhancing that the presence of elevated Lp(a) above 105nmol/L should be considered in all adults as a CV risk-enhancing factor. Recent clinical trials have been documenting some changes up to 25% in the placebo groups. </span></span></p> <p style="margin-left:47px; text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Purpose: </strong>The aim of this study was to evaluate Lp(a) levels variability and its impact on CV risk assessment.</span></span></p> <p style="margin-left:47px; text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Methods: </strong>A retrospective single-center analysis of patients with more than one measurement of Lp(a) levels was conducted. Demographics, CV risk factors, comorbidities and medication use were registered. Context of measurement, time intervals and Lp(a) levels were collected. Change across Lp(a) level of 105 nmol/L as a CV risk-enhancing factors was analyzed. Statistical analysis was done using Chi-square, Mann-Whitney and Kruskal-Wallis tests.</span></span></p> <p style="margin-left:47px; text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Results:</strong> A total of 221 patients were analyzed (157 males, 71.0%), with a median age of 74 [18] years old. Regarding cardiovascular risk factors, 18.1% (n = 40) had obesity, 71% (n = 157) had hypertension, 66.5% (n = 147) had dyslipidemia, and 34.4% (n = 76) had diabetes; active smoking was reported by 14.5% (n = 32) of the patients; only 5% (n = 11) had a family history of CVD. Anti-dyslipidemia treatment was changed between the two analyses in 68 (30.8%) patients. During the first analysis, 34.8% (n = 77) of participants were admitted due to an acute coronary syndrome, 43% (n = 95) were admitted for other reasons, and 22.2% (n = 49) underwent laboratory testing in an ambulatory setting. Lp(a) had a median of 52.10 [141.50] nmol/L in the first analysis. The time interval between measurements was 107 [286] days. Lp(a) in the second analysis had a median of 61.90 [160.3] nmol/L. The second analysis was done in the context of acute coronary syndrome in 27.6% (n = 61) patients, 33.5% (n = 74) were admitted for other reasons, and 38.9% (n = 86) underwent laboratory testing in an ambulatory setting. Lp(a) variation ranged from - 168.30 to 277.10 nmol/L. Lp(a) variability crossed the level of 105 nmol/L in 9.5% (n = 21) of the patients and it was associated with lower age (p = 0.028), obesity (p = 0.020), absence of dyslipidemia (p = 0.026) and smoking habits (p = 0.018). Lp(a) variation by CV risk-enhancing factor cross is represented in Graph 1.</span></span></p> <p style="margin-left:47px; text-align:justify"><strong><span style="font-size:11.0pt"><span style="font-family:"Aptos",sans-serif">Conclusion: </span></span></strong><span style="font-size:11.0pt"><span style="font-family:"Aptos",sans-serif">Lp(a) levels had substantial variability, with nearly 10% of patients crossing the clinically relevant threshold of 105 nmol/L used for cardiovascular risk enhancement. This variability was associated with younger age, higher BMI, fewer dyslipidemia diagnoses, and smoking habits. These findings suggest that contrary to the current assumption of Lp(a) stability, repeat measurements may be warranted to refine recommendations for Lp(a) use in cardiovascular risk assessment.</span></span></p>
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