Prevalence of elevated lipoprotein(a) levels and associated atherosclerotic cardiovascular diseases in subjects with metabolic disorders: A real-world study in a lipid unit

Background and aims Lipoprotein(a) (Lp(a)) is a proatherogenic particle that is considered an important cardiovascular risk modifier due to its association with atherosclerotic cardiovascular disease (ASCVD) as well as calcific aortic valve stenosis (CAVS). Data on the clinical burden associated with elevated lipoprotein(a) levels in patients at high and very high cardiovascular risk remain limited. We evaluated the prevalence of ASCVD and LDL-C target achievement in subjects with high and very high elevated Lp(a) levels referred to a lipid unit. Methods and results In this retrospective study, 1755 subjects were evaluated; 265 with Lp(a) ≥240 nmol/L were included. The population was divided into two groups: high Lp(a) (240–429 nmol/L, n = 216) and very high Lp(a) (≥430 nmol/L, n = 49). ASCVD prevalence was 58% in the very high group and 48% in the high group ( p = 0.23). Age and statin intensity were higher in the very high Lp(a) group. LDL-C target achievement was low in both groups: 20.0% and 25.4% of very high-risk patients reached <55 mg/dL as well as 18.2% and 17.2% of high-risk patients reached <70 mg/dL in very high and high Lp(a) groups, respectively. Conclusions Subjects with elevated Lp(a) levels showed a high prevalence of ASCVD and low LDL-C target attainment despite high-intensity statin therapy. These findings support the need for Lp(a) screening and additional lipid-lowering strategies in high-risk patients.