What is the clinical evidence from this study?

Study design: Cohort. Population: ST-elevation myocardial infarction (n=1106). Intervention: Lipoprotein(a) measurement. Primary outcome: Proportion of patients who had a measurement of Lp(a) prior to or within one year of index STEMI hospitalization.

What question did this study set out to answer?

The study investigates how often Lp(a) is measured in younger patients after STEMI and what predicts its measurement.

April 20, 2026Open Access

Prevalence and predictors of Lipoprotein(a) measurement in younger patients following ST-elevation myocardial infarction.

NANegar AtefiUniversity of British Columbia JYJoshua YoonUniversity of British Columbia FHFarshad HosseiniUniversity of British Columbia

Key Result

Lipoprotein(a) measurement was performed in only 21.7% of younger patients within one year of STEMI, though testing rates increased from 15% to 39% between 2016 and 2023.

Key Points

The study investigates how often Lp(a) is measured in younger patients after STEMI and what predicts its measurement.
Assessed a cohort of patients aged 65 years and younger with STEMI from 2016 to 2023.
Measured the proportion of patients with Lp(a) assessments within one year of STEMI hospitalization.
Analyzed predictors for Lp(a) measurement over patients' lifetimes and examined trends over time.
Only 21.7% of patients had Lp(a) testing within one year of STEMI.
The rate of Lp(a) measurement increased from 15% in 2016 to 39% in 2023.
Older age, prior smoking history, and earlier STEMI year were linked to lower likelihood of Lp(a) measurement.

Study Design

Type

Cohort (n=1,106)

Structured PICO

What is the prevalence and what are the predictors of Lipoprotein(a) measurement in younger patients following ST-elevation myocardial infarction?

Population

1,106 patients aged 18-65 years (mean age 55.9 years; 88.1% male) presenting with ST-elevation myocardial infarction (STEMI) in Vancouver, Canada between January 2016 and January 2023.

Intervention

Measurement of Lipoprotein(a) [Lp(a)] prior to or within one year of index STEMI hospitalization

Comparator

No measurement of Lipoprotein(a)

Outcome

Proportion of STEMI patients with a measurement of Lp(a) prior to or within a year of index STEMI

Despite guideline recommendations, Lipoprotein(a) testing remains underutilized in younger STEMI patients, though measurement rates have improved following the publication of the 2021 Canadian Dyslipidemia guidelines.

Abstract

Background: Lipoprotein(a) Lp(a) is a well-established, independent risk factor for premature atherosclerotic cardiovascular disease.The 2021 Canadian Cardiovascular Society Dyslipidemia recommendations advise Lp(a) measurement as part of cardiovascular risk stratification.However, little is known about the clinical adoption of this recommendation, particularly as undertaken for young patients presenting with acute coronary syndromes.Methods: This study assessed the prevalence and predictors of Lp(a) measurement in a contemporary cohort of patients 65 years presenting with ST-elevation myocardial infarction (STEMI) in Vancouver, Canada between January 2016, and January 2023.The primary outcome was the proportion of such patients who had a measurement of Lp(a) prior to or within one year of index STEMI hospitalization.Secondary analyses explored predictors of Lp(a) measurement at any point in lifetime, as well as measurement trends through years.Results: A total of 1,106 patients were studied (mean age 55.9 years; 88.1% male).Only 240 patients (21.7%) had Lp(a) assessed within one year of STEMI.The rate of Lp(a) measurement increased from 15% to 39% during the interval from 2016-2023 (P<0.01 for trend).Older age (OR 0.67(0.60,0.75), p<0.01), prior history of smoking (0.65(0.46, 0.91), p=0.01), and earlier year of STEMI in the study period (OR 0.83(0.77,0.90), P<0.01) were independently associated with a lower likelihood of Lp(a) measurement.Conclusion: Although rates of measurement have increased from 2016 to 2022, Lp(a) testing remains underutilized among younger STEMI patients.Strategies are needed to increase the testing of Lp(a) amongst younger patients with STEMI, especially with the development of novel targeted therapeutics.

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