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Dr. Jose Javier Gomez-Balado

Credit: Official Association of Physicians of Caceres

Elevated lipoprotein(a) levels affect low-density lipoprotein cholesterol (LDL-C) levels and may negatively impact achieving LDL-C goals in patients with coronary artery disease (CAD), according to a new study. there is.1

In a cross-sectional study conducted in a Spanish cardiology department, the proportion of patients achieving target LDL-C was lower in patients with Lp(a) > 50 mg/dL than in those with Lp(a) ≤50 mg/dL. was shown to be low. .

“The prevalence of high levels of Lp(a) (>50 mg/dL) is higher in patients with CAD than in the general population,” the study team led by José Javier Gómez Balado, M.D., from the Department of Cardiology, wrote. ing. , San Pedro de Alcantara Hospital. “Higher concentrations of Lp(a) are associated with higher LDL-C levels, making it difficult to achieve optimal LDL-C levels established in clinical practice guidelines in these patients.”

Lp(a), like LDL-C, is a molecule with proatherogenic, proinflammatory, and prothrombotic properties.2 Multiple studies have reported its effects on the physiopathological processes of atherosclerosis and other vascular conditions. Although Lp(a) concentration is known to influence serum LDL-C levels, its impact on achieving LDL-C goals has not been well studied.

Recent analysis shows that elevated LP(A) levels are independently associated with long-term risk of major cardiovascular events (MACE), regardless of baseline atherosclerotic cardiovascular disease, in more than 16,000 patients It turned out that it was.3 The risk was most pronounced in patients without baseline ASCVD.

For the current analysis, Gómez-Barrado and colleagues sought to assess the prevalence of elevated Lp(a) in patients with coronary artery disease and assess its impact on achieving LDL-C goals.1 The research team conducted a cross-sectional analysis of 870 consecutive patients with stable CAD from September 2016 to March 2020 in the cardiology department of a tertiary hospital in Spain.

Participants in this study were divided into two groups based on a threshold of Lp(a) 20 proposed by the European Atherosclerosis Society (EAS). Patients were divided into groups with levels of Lp(a) >50 mg/dL and levels of Lp(a). ) ≤50 mg/dL. Logistic regression analysis was performed to assess the association between Lp(a) >50 mg/dL and achievement of LDL-C goals.

Overall, 376 (43.2%) patients had Lp(a) levels >30 mg/dL and 268 (30.8%) patients had >50 mg/dL, with a median Lp(a) level of 22.10. It was mg/dL. Individuals with Lp(a) >50 mg/dL had a higher baseline (142.30 ± 47.54 vs. 130.47 ±40.75 mg/dL; P = .0001) and current (72.91 ± 26.44 vs. 64.72 ± 25.30 mg/dL; P = .0001) level.

This finding was notable even though these patients were treated with higher potency statins (77.2 vs. 70.9%; P = .058) and more concomitant lipid-lowering therapy (37.7 vs. 25.7%; P = .001).

Gómez-Barrado found that the proportion of patients achieving target LDL-C was lower in patients with Lp(a) >50 mg/dL. Independent predictors of elevated Lp(a) levels >50 mg/dL included use of high-potency statins (odds ratio) [OR]1.5; 95% CI, 1.08 – 2.14), combination lipid-lowering therapy with ezetimibe (OR, 2.0; 95% CI, 1.45 – 2.73), and failure to achieve LDL-C ≤55 mg/dL (OR, 2.3; 95% CI), 1.63 – 3.23).

Based on these data, Gómez-Barrado suggested that patients at very high cardiovascular risk need new drugs that act directly on Lp(a).

“In settings of very high cardiovascular risk and elevated Lp(a) levels, the use of other targeted drugs is necessary,” the researchers wrote.

References

  1. Gómez-Barrado JJ, Gómez-Turégano P, Beltrán Moreno M, Fernández-Chamorro AI, Roque Rodríguez B, Kounka Z. Lipoprotein(a) is a predictor of LDL-C goal failure in patients with chronic heart disease. Lipoprotein (a) is a predictor of failure to achieve LDL-C goals in patients with chronic ischemic heart disease. Test for arteriosclerosis. Published online on February 23, 2024. doi:10.1016/j.arteri.2024.01.002
  2. Nordestgaard BG, Langsted A. Lipoprotein(a) as a cause of cardiovascular disease: insights from epidemiology, genetics, and biology. J lipid resolution. 2016;57(11):1953-1975. doi:10.1194/jlr.R071233
  3. Campbell, P. (2024) Elevated lp(a) levels are associated with risk of cardiovascular events, regardless of ASCVD history, HCP Live. Available at https://www.hcplive.com/view/elevated-lpa-levels-linked-to-cardiovascular-event-risk-regardless-of-ascvd-history (accessed March 21, 2024) .

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