Abstract Background Lipoprotein(a) is genetically determined (70-90%), independent, 6x more atherogenic than LDL-C CVD risk factor. Irrespectively of that, in clinical practice we can relatively often see adults and older adults with elevated Lp(a) levels who are generally healthy without signs of atherosclerosis progression. Purpose To investigate what risk factors and conditions are responsible, besides elevated Lp(a) levels, for atherosclerosis progression and CVD diagnosis, and on the other hand whether there are any protective factors that may help to diminish the risk related to Lp(a) elevation. Methods In the STAR (Specialist Care Patients)-Lp(a) study we prospectively enrolled consecutive primary prevention patients (n=2594) referred to 2 outpatient cardiology clinics. Patients for the current analysis were defined as those aged 50 years and with established CVD or those with 2 CVD risk factors. The Lp(a) concentration was determined using enzyme-linked immunosorbent assay. Results Comparing the healthy adults and patients aged 50 years and Lp(a) 30 mg/dL (75 nmol/L) (mean Lp(a) 65.4 vs 72.7 mg/dl, p=0.118), the significant differences were observed for mean age (62.8 vs 69.6 years, p0.001), BMI and number of patients with overweight and obesity (16 vs 32.7%, p=0.001), mean hsCRP (2.12 vs 2.35 mg/L, p=0.007), dyslipidemia, mean glucose and HbA1c (5.44 vs 5.86%, p0.001), and CAC score (43.1 vs 339.9, p0.001). Based on the multivariate analysis, the only independent risk factor of CAC score increase for healthy individuals was non-HDL-C, and age and non-HDL for patients. In the correlation analysis, gender, non-HDL in healthy individuals, and age, gender, non-HDL, HbA1c and Lp(a) for patients correlated significantly with CAC score. Similar comparison of healthy individuals and patients but with Lp(a) levels 50 mg/dL (125 nmol/L) (mean 87.8 vs 88.8 mg/dl, p=0.838) showed even more pronounced differences for age (62.3 vs 69.2, p0.001), female gender (77.8 vs 68.5%, p=0.021), prevalence dyslipidemia, obesity (18.5 vs 31.7%, p=0.001), diabetes with elevated FBG and HbA1c (5.42 vs 5.88%, p0.001), CAC Score (53.1 vs 328.4, p0.001), and heart contraction abnormalities (7.7 vs 15.6%, p=0.044). Multivariate analysis revealed that in patients age and Lp(a) were independent predictors associated with CAC score, while in healthy individuals, elevated hsCRP and gender significantly contributed to CAC increase. Correlation analysis showed that Lp(a), likewise age and HbA1c, were significantly associated with both CAC score and CRP only for patients group. Conclusions In adults 50 years of age with the elevated levels of Lp(a) we can significantly diminish the Lp(a)-related risk of atherosclerosis progression and ASCVD complications by reducing modifiable CVD risk factors like underweight and obesity, prediabetes and diabetes, inflammation and dyslipidemia, investing in our health as early as possible to preferably avoid their occurrence.Table 1
Banach et al. (Sat,) studied this question.