Prevalence of Elevated Lipoprotein(a) and Its Association with Cardiovascular Disease in Patients with Overweight and Obesity in Argentina

Background: Lipoprotein(a) [Lp(a)] is an established independent risk factor for atherosclerotic cardiovascular disease (ASCVD). Although both obesity and elevated Lp(a) are highly prevalent, their interrelationship and combined impact on ischemic heart disease (IHD) remain incompletely understood, particularly in Latin American populations. Objective: To evaluate the distribution of elevated Lp(a) across body mass index (BMI) categories, assess its association with ischemic heart disease (IHD), and determine whether this association differs across BMI categories. Methods: We conducted a multicenter observational study including 2975 adults from specialized centers in Argentina. Patients were stratified into BMI categories: Group 1: < 25, Group 2 BMI: 25– 29.9, Group 3: 30– 34.9 kg/m 2 , with exploratory subgroups ≥ 35 and ≥ 40 kg/m 2 . Elevated Lp(a) was defined as > 50 mg/dL or > 125 nmol/L. Results: Median Lp(a) levels decreased across higher BMI categories. The prevalence of elevated Lp(a) declined across increasing BMI categories (34.6% in BMI < 25 kg/m 2 , 29.8% in BMI 25-29.9, 30.1% in BMI ≥ 30, 26.4% in BMI ≥ 35 and 24.6% in BMI ≥ 40). However, after adjustment for demographic and cardiometabolic factors, overweight and obesity were associated with higher odds of elevated Lp(a) compared with normal weight (BMI 25– 29.9: OR 1.97, 95% CI 1.38– 2.82; BMI ≥ 30: OR 1.85, 95% CI 1.22– 2.81) suggesting that crude prevalence estimates and adjusted associations were influenced by differences in baseline risk profiles across BMI categories. Elevated Lp(a) was independently associated with IHD across all BMI categories, without significant interaction between BMI and Lp(a). Conclusions: In this cross-sectional study, elevated Lp(a) was associated with prevalent ischemic heart disease across BMI categories despite lower crude prevalence among individuals with higher BMI. Because of the observational cross-sectional design, causal inferences cannot be made. Nevertheless, these findings support consideration of Lp(a) assessment across the BMI spectrum.