Key result
Elevated Lp(a) is associated with higher risk of recurrent major cardiovascular events in very young ACS survivors.
Why the study?
Lipoprotein(a) is a causal risk factor for cardiovascular disease and is particularly associated with premature ACS, but its role in predicting recurrent events in very young ACS survivors is unclear.
Does elevated Lipoprotein(a) predict recurrent major adverse cardiovascular events in patients who experienced their first acute coronary syndrome at ≤40 years of age?
Cohort (n=378)
Does elevated Lipoprotein(a) predict recurrent major adverse cardiovascular events in patients who experienced their first acute coronary syndrome at ≤40 years of age?
Answers are grounded in this paper and cite their sources.
Elevated Lipoprotein(a) concentrations are independently associated with a significantly higher risk of recurrent MACE in very young survivors of acute coronary syndrome.
BACKGROUND: Lipoprotein(a) [Lp(a)] is a causal risk factor for cardiovascular disease, and it is particularly associated with premature acute coronary syndrome (ACS). We investigated whether elevated Lp(a) can predict recurrent cardiovascular events in patients who experienced their first ACS less than or equal to 40 years of age. METHODS: Within the STudy of eArly Myocardial INfArction registry, we recruited 405 consecutive patients who survived their first ACS less than or equal to 40 years of age; of them 378 had complete follow-up data. Clinical endpoint was the development of major adverse cardiovascular events (MACE; i.e. cardiac death, readmission for ACS or malignant ventricular arrhythmias, ischemic stroke, or coronary revascularization due to clinical deterioration). Multi-adjusted Cox regression was used to assess the association between Lp(a) and first recurrent MACE risk. RESULTS: Of the 378 ACS survivors (33.7 ± 4.3 years), 139 (36.8%) experienced a MACE over a median 8-year (5.2-12.5 years) follow-up. Elevated Lp(a) showed a borderline independent association with higher recurrent MACE [hazard ratio per 1 mg/dl: 1.004, 95% confidence interval (CI): 0.999-1.009, P = 0.051]. Moreover, patients with baseline Lp(a) levels greater than or equal to 50 mg/dl had 82.6% higher risk of MACE as compared with those below (hazard ratio 1.826, 95% CI: 1.141-2.925, P = 0.012); similarly, patients with Lp(a) ≥ 70 mg/dl had 118% higher risk as compared with those below (hazard ratio 2.180, 95% CI: 1.330-3.573, P = 0.002). CONCLUSION: Elevated Lp(a) concentrations demonstrate an independent association with recurrent MACE among very young ACS survivors. Until targeted Lp(a)-lowering treatments become clinically available, an aggressive lipid-lowering approach may be warranted to partially attenuate Lp(a)-related residual cardiovascular risk.
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Rallidis et al. (2026) conducted a cohort in Premature acute coronary syndrome (ACS) (n=378). Elevated Lipoprotein(a) [Lp(a)] vs. Lower Lp(a) levels (<50 mg/dl) was evaluated on Major adverse cardiovascular events (MACE; cardiac death, readmission for ACS or malignant ventricular arrhythmias, ischemic stroke, or coronary revascularization due to clinical deterioration) (HR 1.826, 95% CI 1.141-2.925, p=0.012). Baseline Lipoprotein(a) levels ≥/dl were associated with an 82.6% higher risk of recurrent major cardiovascular events in very young ACS survivors compared to those with lower levels.
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