Key result
Female sex is linked to higher Lp(a) categories among patients undergoing CABG.
Why the study?
High Lp(a) is a cardiovascular risk factor and Lp(a)-lowering therapies are under investigation, but sex/gender-specific differences in Lp(a) distribution among patients undergoing CABG remained to be assessed.
Does the distribution of Lp(a) levels differ between male and female patients undergoing CABG?
Cross-Sectional (n=404)
No
Does the distribution of Lp(a) levels differ between male and female patients undergoing CABG?
Absolute Event Rate: 37.4% vs 27.8%
p-value: p=0.165
Women undergoing CABG have a higher prevalence of significantly elevated Lp(a) levels compared to men, which may contribute to worse postoperative outcomes and highlights a subgroup that could benefit from emerging Lp(a)-lowering therapies.
Women undergoing CABG more often exceed high Lp(a) thresholds; hypothesis-generating for sex-specific eligibility criteria pending prospective validation.
High lipoprotein (a) is a risk factor for the development of cardiovascular disease. Lp(a) lowering medications are under investigation in clinical trials. We aimed to assess sex/gender-specific differences in the distribution of Lp(a) levels in patients undergoing coronary artery bypass grafting (CABG). This is a prospective, cross-sectional observational trial including patients undergoing CABG. Patients were classified into Lp(a) categories (Lp(a) (nmol/l) < 62, > 105; ≥ 150; ≥ 175; ≥ 200). Univariate and multivariate analyses were used to test for sex/gender-specific differences in Lp(a) distribution. Out of all 413 patients undergoing CABG between 11/2024 and 02/2026, 300 patients signed informed consent and 404 had available Lp(a) values. Women were significantly older ( p < 0.001), more often never smokers ( p = 0.001) and more frequently had a positive family history ( p = 0.001). Median Lp(a) levels did not significantly differ between male and female patients in all 404 patients with available Lp(a) levels (27.8 (IQR 118) versus 37.4 (IQR 206.4); p = 0.165). Female patients were significantly more often distributed in Lp(a) categories > 105 nmol/l, ≥ 150 nmol/l, ≥ 175 nmol/l and ≥ 200 nmol/l, also after adjustment in multivariate analysis. A sex/gender-specific difference in Lp(a) distribution was observed. Female patients were more often distributed in higher Lp(a) categories than men, especially in Lp(a) categories > 105, ≥ 150, ≥ 175 and ≥ 200 nmol/l. If Lp(a) lowering agents prove to be effective in clinical trials and currently investigated Lp(a) thresholds are adopted, female patients undergoing CABG may represent a subgroup more likely meeting future treatment eligibility criteria for Lp(a) lowering therapies. The observed difference in Lp(a) distribution may yield a potential contributor to the consistently reported poorer clinical outcomes in women after CABG and warrants further investigation.
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Abfalterer et al. (2026) conducted a cross-sectional in Coronary artery disease requiring coronary artery bypass grafting (n=404). Female sex vs. Male sex was evaluated on Median Lp(a) levels (nmol/l) (p=0.165). Although median Lp(a) levels did not significantly differ overall, female patients undergoing coronary artery bypass grafting were significantly more often distributed in higher Lp(a) categories (>105, ≥150, ≥175, and ≥200 nmol/l) compared to male patients.
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