Lipoprotein(a) and Acute Coronary Syndrome: Associations with Sex, Age and Traditional Cardiovascular Risk Factors

Abstract

Background: Lipoprotein(a) [Lp(a)] is an independent risk factor for coronary disease due to its atherogenic, proinflammatory, and prothrombotic properties. Current guidelines recommend a single measurement in adults to refine the risk of acute coronary events. Objectives: We aim to characterize Lp(a) levels in acute coronary syndrome (ACS) patients and explore associations with sex, age, comorbidities and traditional cardiovascular risk factors (TCVRF). Methods: We conducted a cross-sectional study including ACS patients admitted from January 2022 to December 2023 in our center with Lp(a) levels measured at admission. Patients were stratified into two groups: >100 nmol/L vs. ≤100 nmol/L. Demographic and clinical data, including TCVRF (dyslipidemia, diabetes, hypertension, smoking, obesity), were collected from hospital records. Chi-square and Independent T or Mann-Whitney tests compared categorical and quantitative variables, respectively. Results: Of the 388 patients (19.6% women, 80.4% men) included, 61.3% had Lp(a) ≤100 nmol/L and 38.7% had Lp(a) >100 nmol/L; 32.5% had premature coronary disease. No significant differences were found in age, TCVRF and comorbidities between groups. While 10.7% of patients had no TCVRF, 89.3% had at least one. Lp(a) levels were similar across TCVRF categories, but among those without TCVRF, women had higher Lp(a) levels than men (p=0.003). No correlation was observed between Lp(a) and other lipidic parameters. Conclusions: Lp(a) levels had an heterogeneous distribution in our population. However, a trend indicating higher Lp(a) levels in women with ACS compared to men was observed. These findings support screening regardless of TCVRF or comorbidities, especially in female patients.