Assessment of the trends in lipoprotein(a) concentration in high-risk cardiovascular patients: A retrospective study.

Abstract

Background: Cardiovascular disease (CVD) affects 500 million people globally, with mortality over 20 million. In the UK, the financial burden is estimated to be approximately £54 billion. Consequently, Lp(a) has been incorporated as an additional biomarker for cardiovascular risk stratification. It is used as a superior marker over the traditional marker LDL-C.

Methods: This was a single-centre retrospective study conducted at Hampshire Hospital NHS Foundation Trust spanning 16 months (September 2022-January 2024). Lp(a) results were retrieved from the laboratory database and assessed for trends. The distribution of Lp(a) results was also compared with the values outlined in the HEART UK consensus statement (2019). Additionally, demographic characteristics such as age, sex, medical history, and lifestyle factors were collected. Personal details, including names, addresses, and phone numbers, were anonymised to ensure confidentiality. A total of 192 patients were included in the study. These patients were referred for a lipid panel by lipid specialists (172), GP surgeries (10), cardiologists (5), unspecified consultants (3) and endocrinologists (2). All patients were over 18 years of age. They were attending the clinic and had been screened for dyslipidaemia and high cardiovascular risk, including conditions such as familial hypercholesterolaemia, renal dysfunction, and those on antilipid therapy.

Results: The demography included 99 (52%) females and 93 (48%) males. The chronological age (mean ± SD) was 61.17 ± 13.18 for females and 53.91 ± 12.84 for males (p < 0.001). Additionally, the Lp(a) values were 126.50 ± 118.92 and 135.33 ± 99.59 (p < 0.01) for females and males, respectively. The analysed samples were categorised as normal ( ≤ 32 nmol/L) and abnormal (>32 nmol/L) concentrations of Lp(a), with normal results observed in 104 patients and abnormal results in 88 patients: Lp(a) ≤ 32 nmol/L (54%) versus >32 nmol/L (46%), p < 0.0001. According to the CVD risk groupings established by HEART UK, 54%, 12%, 18%, 15% and 1% of the patients had Lp(a) values of 12.2 ± 7.5, 52.20 ± 16.42, 147.14 ± 36.64, 291.71 ± 62.49, and 471.50 ± 28.99 nmol/L, classified as normal, minor risk, moderate risk, high risk, and very high risk, respectively.

Conclusion: This study provided evidence supporting the inclusion of Lp(a) as an extra component in lipid profile testing. Elevated levels of Lp(a) are associated with an increased risk of CVD, which may be more significant than the risk posed by LDL-C. Incorporating Lp(a) as a routine biomarker in real-world clinical practice would accurately stratify cardiovascular risk, particularly for patients with elevated Lp(a) concentrations, and could potentially be a more significant risk than LDL-C in individuals at high risk for CVD, especially for those ≥ 50 years of age.