Abstract Introduction Individually, the presence of any traditional cardiovascular risk factor does not reliably predict the extent of coronary artery disease nor the difficulty in achieving lipid-control targets. Lipoprotein(a) Lp(a) has emerged as a promising candidate to explain these cases. Objectives The aims of the study were to assess whether elevated Lp(a) levels are associated with greater coronary artery disease burden in patients with ischemic heart disease, and to evaluate their impact on achieving LDL-control targets. Methods This was a retrospective observational study that included consecutive patients with ischemic heart disease treated in a Cardiac Rehabilitation Unit between January 2023 and November 2025. Demographic, clinical, angiographic, and follow-up variables were collected and analyzed according to Lp(a) levels. Statistical analysis was performed using SPSS v23. Results A total of 575 patients were included, 456 of whom were men (79.3%), with a mean age of 62.4 ± 10.0 years. Elevated Lp(a) levels (50 mg/dL) were present in 240 patients (41.74%). These patients showed a higher prevalence of a history of premature ischemic heart disease (55.96% vs. 38.28%, p0.001), recurrence of at least one coronary event (54.79% vs. 39.72%, p=0.015), and a greater proportion of multivessel coronary artery disease (48.57% vs. 36.16%, p=0.003). Elevated Lp(a) was also associated with a more frequent need for triple lipid-lowering therapy to achieve LDL control (59.62% vs. 39.96%, p=0.006). Moreover, an Lp(a) level above 75 mg/dL was associated with poorer rates of achieving secondary-prevention lipid targets: LDL 55 mg/dL in 36.64% vs. 26.83% (p=0.021); Apolipoprotein B 65 mg/dL in 42.03% vs. 28.80% (p=0.036). Conclusions Elevated Lp(a) may serve as a marker of greater coronary atheroma burden, higher recurrence of events, and increased difficulty in achieving lipid-control targets in secondary prevention. This could help identify individuals who require more intensive therapy from the outset in order to improve long-term prognosis.Table 1For image description, please refer to the figure legend and surrounding text. Table 2For image description, please refer to the figure legend and surrounding text.
Sierra et al. (Mon,) studied this question.