Distribution of lipoprotein(a) and its association with atherosclerotic cardiovascular disease in a large real-world Polish cohort

Background Lipoprotein(a) [Lp(a)] is an established cardiovascular risk factor, but large-scale contemporary real-world data from Poland remain limited. Objective To assess the distribution of Lp(a) levels, their associations with cardiovascular conditions, and their relationship with conventional lipid parameters in adults undergoing testing within the LUX MED network in Poland. Methods This retrospective observational study included 23,654 adults with Lp(a) measurements reported in nmol/L. ASCVD included coronary artery disease (CAD), previous myocardial infarction (MI), or previous stroke/transient ischemic attack (TIA). Multivariable logistic regression models for the ASCVD, CAD, previous MI, and stroke/TIA were adjusted for age, sex, body mass index (BMI), LDL-C, HDL-C, and triglycerides. Results Median Lp(a) was 12.7 nmol/L (IQR, 7.0–47.0). Lp(a) levels showed weak positive correlations with age, BMI, total cholesterol, and LDL-C, with no meaningful correlation with HDL-C. In fully adjusted models, ln(Lp(a)+1) was independently associated with the ASCVD (OR 1.15, 95% CI 1.07–1.24), CAD (OR 1.21, 95% CI 1.12–1.32), and previous MI (OR 1.78, 95% CI 1.31–2.41), but not with stroke/TIA (OR 0.97, 95% CI 0.86–1.09). Compared with Lp(a) <62 nmol/L, levels ≥105 nmol/L were associated with the ASCVD, CAD, and previous MI. Associations for ASCVD and CAD were consistent in sensitivity analyses including up to the entire cohort and at the ≥125 nmol/L threshold, and among patients with LDL-C <70 mg/dL. Conclusions In this large real-world Polish cohort, elevated Lp(a) levels were common and independently associated with major manifestations of ASCVD, supporting measurement of Lp(a) as part of comprehensive lipid evaluation.