Lipoprotein(a) epidemiology and role in secondary and primary-and-a-half cardiovascular prevention: From subclinical atherosclerosis to coronary events

Introduction Lipoprotein(a) (Lp[a]) is an independent risk factor for atherosclerotic cardiovascular events and aortic stenosis. In Spain, the prevalence of elevated Lp(a) and its clinical impact remain poorly defined. Methods We conducted a cross-sectional study including two cohorts: patients discharged after a non-fatal acute coronary syndrome (secondary prevention), and asymptomatic patients with subclinical atherosclerosis (“1.5 prevention”). The prevalence of elevated Lp(a) levels was assessed in both groups. Associations with multivessel coronary artery disease (secondary prevention) and with a coronary artery calcium (CAC) score ≥300 AU (1.5 prevention) were analyzed. Results A total of 1043 patients were included (788 secondary prevention). Median Lp(a) levels were 61 nmol/L in secondary prevention and 29 nmol/L in the 1.5 prevention cohort. In secondary prevention, 36.8%, 33.6%, 29.2%, and 24.5% had Lp(a) ≥125, ≥150, ≥175, and ≥ 200nmol/L, respectively; in the 1.5 prevention cohort the corresponding proportions were 27.5%, 24.3%, 17.6%, and 14.1%. In secondary prevention, Lp(a) ≥175 nmol/L was associated with multivessel disease after multivariable adjustment for age, sex, LDLc, and statin treatment (OR 1.45, 95% CI: 1.04–2.01; p = 0.027). In 1.5 prevention, Lp(a) ≥175 nmol/L showed a prevalence of CAC ≥300 AU of 86%. Elevated Lp(a) (≥175 nmol/L) was associated with CAC ≥300 AU (OR 4.47, 95% CI 1.39–20.07; p = 0.023), although this association lost significance after multivariable adjustment. Conclusions Elevated Lp(a) levels are common in both populations and correlate with greater atherosclerotic burden. These findings support the systematic assessment of Lp(a) to guide preventive strategies across both patient populations.