Objective: To assess the relationship between Lp (a), low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (ApoB), and blood pressure control in predicting major adverse cardiovascular events (MACE) in the Argentine multicenter GAELp (a) cohort. Design and method: We analyzed 2, 864 patients with available data on Lp (a), LDL-C, and blood pressure. ApoB measurements, however, were available in 1, 816 out of 3, 652 participants (49. 7%). All analyses including ApoB were therefore restricted to this subset. Among hypertensive patients, 1, 051/2, 052 (51. 2%) had ApoB values available. Lp (a) values were standardized to nmol/L (conversion factor 2. 5 if mg/dL). Controlled blood pressure (BPcontrol) was defined as systolic <130 mmHg and/or diastolic <80 mmHg among hypertensive patients. MACE was defined as ischemic heart disease, peripheral artery disease, or prior ischemic stroke. Logistic regression models were adjusted for age, sex, LDL-C, ApoB, statin use, and blood pressure control. Incremental value was assessed using AUC, NRI, IDI, Brier score, spline modeling, heatmaps, and decision curve analysis. Results: Lp (a) provided incremental predictive value over LDL-C and ApoB (Lp (a) improved model discrimination metrics (AUC, NRI, IDI) ; Brier < 0). The association between Lp (a) and MACE was stronger in patients with controlled blood pressure, suggesting a residual risk independent of hemodynamic load. In contrast, in uncontrolled hypertension, the Lp (a) -MACE association was attenuated. Decision curve analysis demonstrated greater net benefit for the model including Lp (a) across risk thresholds of 5–20%. Conclusions: Elevated Lp (a) is associated with residual cardiovascular risk beyond LDL-C and ApoB, particularly in patients with well-controlled blood pressure. These findings highlight the relevance of Lp (a) screening to identify high-risk individuals despite optimal hypertension management.
RENNA et al. (Fri,) studied this question.