Experiences with Lp(a) level monitoring in young patients after myocardial infarction

Abstract It has been known for years that Lp(a) is a genetically determined, independent risk factor for coronary artery disease and acute myocardial infarction. Due to the lack of treatment options, its routine determination was not performed regularly for years. With the advancement of PCSK-9 inhibitors, it became possible to reduce Lp(a) levels by 20-30%, thereby reducing CV risk. We examined early post-infarction rehabilitation patients in our rehabilitation department. According to our working hypothesis, elevated Lp(a) as an independent CV risk factor occurs cumulatively in low-risk infarction patients. Based on the above, we selected those from the patients after myocardial infarction who came to us for early rehabilitation who: 1.: were younger than 60 years old 2: have not been treated for diabetes before 3: have no former CV event in their anamnesis 4.: and whose LDL - cholesterol level was lower than 3,4 mmol/ l (before the starting of statin therapy). In cooperation with the Military Hospital, during the past year we found a total of 38 such patients, who underwent Lp(a) testing both after the acute event and in the second week of the rehabilitation program. Of the patients, 28 were male and 10 were female. The average age was 52 years (between 38 and 60 years). According to the selection criteria, diabetes and previous treatment for coronary artery disease were not included. 31 patient had a history of hypertension, 27 of them smoked. Laboratory results revealed elevated Lp(a) in 21 patients, with an average elevation of 2.2x the upper limit of normal value, and a maximum of 11x the upper limit of normal. Compared to the average population in the literature, the elevated Lp(a) level in the present study cohort was 4.5x. The above pilot definition draws attention to the fact that in the case of low-risk, young infarcted patients, routine Lp(a) screening and possible treatment can complement the patient's risk stratification, and - with appropriate treatment alternatives - the global risk can be reduced in the patients described above.