Lipoprotein(a) and early LDL-cholesterol target attainment after a first acute coronary syndrome: a real-world cohort study

Background Despite intensive lipid-lowering therapy, early attainment of the guideline-recommended LDL-cholesterol (LDL-C) target after acute coronary syndrome (ACS) remains suboptimal. Baseline factors associated with early LDL-C target attainment remain incompletely characterized, particularly the role of lipoprotein(a) [Lp(a)]. We aimed to assess early LDL-C target attainment after a first ACS and identify baseline factors associated with target attainment, with a particular focus on Lp(a). Methods We conducted a retrospective cohort study of consecutive hospitalized adults with a first ACS undergoing percutaneous coronary intervention between January 2025 and April 2026. The primary endpoint was attainment of the guideline-recommended LDL-C target at early follow-up, defined as LDL-C < 55 mg/dL and a ≥ 50% reduction from baseline. Associations between clinical variables and LDL-C target attainment were assessed using multivariable logistic regression. Results Eighty-two patients were included; 70.7% were male and 37.2% had elevated Lp(a) levels. At a median follow-up of 5 weeks (IQR, 4–6), 31.7% attained the LDL-C target despite prescription of high-intensity statin therapy at discharge. In the multivariable model, low Lp(a) (OR 8.72; 95% CI 2.04–37.33), current smoking (OR 5.29; 95% CI 1.42–19.69), and ezetimibe use in addition to high-intensity statin therapy at discharge (OR 5.28; 95% CI 1.31–21.32) were associated with LDL-C target attainment. Conclusions Early LDL-C target attainment after a first ACS remained limited despite routine prescription of high-intensity statin therapy. Elevated Lp(a) was associated with a lower likelihood of attaining the LDL-C target. Prospective studies are needed to confirm these findings.