Abstract Background/Introduction Atherosclerotic cardiovascular diseases (ASCVD) are the leading causes of morbidity and mortality worldwide. Lipoprotein(a) Lp(a) has emerged as an important genetically mediated biomarker, with elevated levels linked to an increased risk of ASCVD. Understanding the interplay between Lp(a) concentrations and the risk of ASCVD events in a large mixed-race population cohort is crucial for proper risk stratification and cardiovascular prevention. Purpose This study aims to evaluate the impact of elevated Lp(a) levels and historical risk biomarkers on the time to onset of ASCVD outcomes in a Brazilian population followed at a tertiary hospital. Methods This retrospective, observational, and longitudinal study utilizes the Lipid Clinic database at the Heart Institute (InCor). Data from June 2006 and October 2019 were obtained through direct electronic extraction of patients’ medical records. All patients over 18 years and with at least one Lp(a) measure were included. Patients were grouped based on Lp(a) levels: low ( 50 mg/dL), medium (51-70 mg/dL), high (71-90 mg/dL), and very high ( 90 mg/dL). A descriptive analysis of demographic and clinical data was performed. To analyze factors associated with incident vascular outcomes, multivariate Cox regression was used, providing hazard ratios (HR) with 95% confidence intervals (CI) and a significance level of p 0.05. Event-free survival analysis was conducted using the Kaplan-Meier (KM) method, with comparisons made using the log-rank test (p 0.05). Results A total of 4,831 patients were enrolled, with a mean age of 60 ± 14.6 years; 54% were female, and 88% were white (as determined by the evaluator). Incident outcomes included 21% of patients undergoing revascularization, 18% experiencing myocardial infarction, and 3% presenting a stroke. Male sex, older age, previous ASCVD, smoking, dyslipidemia, and statin use were independently associated with incident events. Lp(a) concentration significantly affected the risk of events, particularly in patients with levels above 90 mg/dL (Figure 1). Event-free survival is lower in patients with Lp(a) levels above 90 mg/dL (Figure 2). Conclusion Our findings highlight the importance of measuring plasma Lp(a) and considering patient history for comprehensive risk assessment. These insights can inform targeted prevention strategies and improve clinical outcomes for patients at risk of cardiovascular diseases.Figure 1 Figure 2
Rocha et al. (Sat,) studied this question.