Interaction between elevated lipoprotein(a) and LDL cholesterol on mortality risk in patients with coronary artery disease

Lipoprotein(a) [Lp(a)] is a causal genetic risk factor and associates with cardiovascular disease (CVD) risk.1 The recently presented consensus statement from the European Atherosclerosis Society recommends intensive risk factor management in patients with elevated Lp(a) due to the lack in availability of specific Lp(a)-lowering therapies.2 This recommendation is supported by secondary analyses of cardiovascular outcomes trials of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, where absolute cardiovascular risk reduction with this treatment was higher at higher baseline Lp(a) levels.3,4 However, while the majority of data available on the association of Lp(a) with CVD risk is based on primary prevention, the link between Lp(a) and long-term prognosis of patients with existing atherosclerotic CVD is less well defined. The present large single-centre registry tested the hypothesis that Lp(a) associates with long-term mortality in patients with coronary artery disease following percutaneous coronary intervention. In specific, we aimed to evaluate whether a potential link between Lp(a) on patients’ prognosis may be modified by LDL cholesterol control.