SPC365

Lipoprotein(a) and Cardiovascular Risk Stratification: Insights from SCORE2-Based Risk Categories in a Portuguese Community-Based Study

Session: Sessão de Posters 07 - Lípidos para além do LDL: a nova fronteira do risco
Speaker: Tiago Prata Branco

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: Tiago Prata Branco; Rafael Costa; Giulia Rinaldi; Luana Alves; Tiago Silva; Silvia O Diaz; Rui Rodrigues; Mariana Vasconcelos; Marta Tavares Silva; Francisca Saraiva; Tiago Guimarães; Adelino Leite-Moreira

<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:Arial,sans-serif"><span style="color:black">Introduction:</span></span></strong>&nbsp;<span style="font-family:Arial,sans-serif"><span style="color:black">Lipoprotein(a) [Lp(a)] is a well-established causal and independent risk factor for atherosclerotic cardiovascular disease (ASCVD), with a continuous association between circulating levels and cardiovascular outcomes. Despite this evidence, Lp(a) is not incorporated into SCORE2, SCORE2-OP or SCORE2-DM, the recommended tools for 10-year ASCVD risk estimation in Europe. As Lp(a) is genetically determined, stable throughout life and considered a potential risk modifier, its measurement may reveal cardiovascular risk not captured by traditional SCORE2 variables. Understanding how Lp(a) distributes across SCORE2-based categories may help identify individuals with unrecognised cardiovascular risk.</span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:14px"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:Arial,sans-serif"><span style="color:black">Purpose:</span></span></strong><span style="font-family:Arial,sans-serif"><span style="color:black">&nbsp;The aim of this study was to evaluate the association between Lp(a) concentrations and SCORE2, SCORE2-OP and SCORE2-DM cardiovascular risk categories in a real-world Portuguese community-based cohort.</span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:14px"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:Arial,sans-serif"><span style="color:black">Methods:</span></span></strong><span style="font-family:Arial,sans-serif"><span style="color:black">&nbsp;A cross-sectional cardiovascular screening programme was conducted across three northern&nbsp;localities in Portugal. Eligible participants were volunteers aged &ge;40 years withou previous cardiovascular events. Screening followed a standardised protocol including anthropometric assessment, blood pressure measurement, a structured lifestyle and clinical questionnaire, and venous blood sampling. Ten-year ASCVD risk was estimated using SCORE2/SCORE2-OP/SCORE2-DM according to age group. Lp(a) was analysed as a continuous variable and also dichotomised using the threshold &ge; 50 mg/dL.</span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:14px"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:Arial,sans-serif"><span style="color:black">Results:</span></span></strong><span style="font-family:Arial,sans-serif"><span style="color:black">&nbsp;A total of 160 participants were included, with a mean age of 67 years and 71% being male. The overall median Lp(a) concentration was 21 mg/dL (IQR 8&ndash;56), and 28% presented Lp(a) &ge;50 mg/dL. Median Lp(a) levels were similar across SCORE2-based cardiovascular risk categories: 20.8 mg/dL in low&ndash;moderate risk individuals (n=31, 21%), 22.7 mg/dL in high-risk individuals (n=82, 56%) and 15.1 mg/dL in very high-risk individuals (n=34, 23%). No statistically significant differences were observed (Kruskal&ndash;Wallis &chi;&sup2;=1.01; p=0.60). Sex, age, body mass index, traditional cardiovascular risk factors and high-sensitivity C-reactive protein levels also did not differ significantly between groups.</span></span></span></span></span></p>

<p style="text-align:start"><span style="font-size:14px"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><strong><span style="font-family:Arial,sans-serif"><span style="color:black">Conclusion:</span></span></strong><span style="font-family:Arial,sans-serif"><span style="color:black">&nbsp;In this community-based cohort, Lp(a) levels did not vary across SCORE2/SCORE2-OP/SCORE2-DM risk categories, suggesting that Lp(a) reflects an independent dimension of cardiovascular risk not captured by current risk algorithms. These findings reinforce current recommendations to measure Lp(a) at least once in a lifetime, particularly to identify residual cardiovascular risk among individuals classified as low or moderate risk by SCORE2-based tools. They also generate the hypothesis that larger population-based studies with longitudinal follow-up may clarify whether incorporating Lp(a) improves cardiovascular risk re-stratification.</span></span></span></span></span></p>