High lipoprotein(a) levels in patients with very high cardiovascular risk: incidence and association with other risk factors

Lipoprotein(a) (Lp(a)) is a significant independent cardiovascular risk factor (CVR) associated with the development of atherosclerotic cardiovascular disease (CVD), heart failure, atrial fibrillation, and increased overall and cardiovascular mortality. The aim of the study: to assess the incidence of elevated Lp(a) levels (> 75 nmol/L) in patients with very high CVR, as well as to analyze differences in clinical and laboratory characteristics and drug therapy between groups with normal and elevated Lp(a). Material and methods . A retrospective analysis of outpatient records of patients with very high CVR (n = 76, 63.2 % men, median age 61.0 [51.0; 70.0] years) who visited the Lipid Center of the Research Institute of Therapeutic, Preventive and Microbiological Medicine, a branch of the Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, from July 2025 to April 2026. All patients included in the study underwent clinical laboratory testing. Results . In the analyzed group of patients with very high CVR, the incidence of elevated Lp(a) ≥ 75 nmol/L was 38.2 %, and ≥ 125 nmol/L – 31.6 % of patients. In the group with elevated Lp(a) levels, patients were younger (55.0 [47.0; 68.5] and 64.0 [53.0; 71.0] years, p = 0.019), had earlier onset of CVD (53.5 [49.5; 60.5] and 62.0 [51.0; 66.0] years, p = 0.022), and were more likely to have a family history of CVD (89.7 % and 46.8 %, p = 0.012). In the group with elevated Lp(a) levels, higher TC (4.9 [3.4; 6.2] mmol/L vs. 4.3 [3.6; 5.9] mmol/L, p = 0.765) and LDL-C (2.6 [1.6; 3.9] mmol/L vs. 2.0 [1.5; 4.0] mmol/L) values were observed, but without reaching statistical significance (p = 0.460). The proportion of patients who achieved the target LDL-C level was low and did not differ between the groups. In patients who did not achieve the target LDL-C level, the median Lp(a) was higher (45.0 [20.0; 190.5] nmol/L) compared to patients who achieved the target LDL-C level (20.0 [20.0; 225.0] nmol/L), but the difference did not reach statistical significance (p = 0.533). Conclusions. The incidence of elevated Lp(a) levels (>75 nmol/L) in patients with very high CVD was 38.2 %. Patients with elevated Lp(a) levels are characterized by earlier onset of CVD, a positive family history, and insufficient efficacy of standard lipid-lowering therapy in reducing LDL-C.