Lipoprotein(a) and an aggressive coronary disease phenotype: Association with multivessel disease and recurrent coronary events in the CERES study

BACKGROUND Lipoprotein(a) [Lp(a)] is an established genetically determined risk factor for atherosclerotic cardiovascular disease. Whether elevated Lp(a) identifies a broader phenotype of aggressive coronary disease, integrating anatomical disease burden and recurrent clinical manifestations, remains incompletely characterised. METHODS We analysed 1892 patients with coronary artery disease from the multicentre CERES cohort after exclusion of myocardial infarction with non-obstructive coronary arteries (MINOCA). Lp(a) was analysed continuously, after natural-log transformation, and categorically using >50 mg/dL. Multivariable logistic regression models were adjusted for age, sex, hypertension, diabetes, smoking, and historical maximum LDL cholesterol (LDL-C). RESULTS Lp(a) was available in 1833 patients; median concentration was 24.7 [9.1-63.7] mg/dL, and 33.2% had Lp(a) >50 mg/dL. Multivessel disease was present in 50.4% and recurrent coronary events in 19.5%. Lp(a) was independently associated with multivessel disease (OR, 1.004; 95% CI, 1.001-1.006; p = 0.002) and recurrent coronary events (OR, 1.004; 95% CI, 1.001-1.006; p = 0.003). Lp(a) >50 mg/dL was associated with multivessel disease (OR, 1.406; 95% CI, 1.144-1.730; p = 0.001) and recurrent events (OR, 1.504; 95% CI, 1.166-1.942; p = 0.002). CONCLUSIONS Elevated Lp(a) was independently associated with greater anatomical coronary disease burden and recurrent coronary events, supporting its role as a marker of an aggressive coronary disease phenotype.