Lp(a) in daily clinical routine: risk-factor for both cardiovascular events and heart-failure? A retrospective analysis of the Luebeck Lp(a) heart-failure (HF) registry in patients after myocardial infarction

Abstract

Background and aims

Atherosclerotic cardiovascular disease (ASCVD) is a major health burden being the leading cause of death in Europe. Lipoprotein (a) (Lp(a)) is an important risk factor for CV events reflected by the 2019 ESC recommendation of a once in a lifetime Lp(a) measurement. Furthermore, heart-failure (HF) is the number one diagnosis for hospital admission in Germany and Europe. HF and ASCVD share common well-known risk factors, e.g. diabetes, obesity and hypertension. So far, there is scarcity of data regarding the relationship between Lp(a) and HF. We hypothesized that Lp(a) might be elevated in a high-risk ASCVD patient collective and that there might also be an association with heart-failure.

Methods

The Luebeck Lp(a) HF registry is a combined retrospective/prospective single-center, all-comers registry which investigates the relationship between Lp(a) and HF. The retrospective analysis reported here, comprises patients who were admitted to our heart-catheterization laboratory in the year 2021 due to ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI).

Results

We found that Lp(a) was assessed only in a minority of patients presenting with STEMI (33 %) and NSTEMI (14.6 %), p < 0.001. There was no relationship between Lp(a) level and ejection fraction (EF) or NTproBNP as surrogate markers for HF, respectively. Statin pretreatment was more frequent in patients with NSTEMI (31.1 %) compared to STEMI patients (11.3 %), p < 0.001.

Conclusion

Despite ESC recommendation, routine Lp(a) measurement is only rarely performed even in a high-risk patient collective. In patients with MI, we could retrospectively not observe a correlation between Lp(a) levels and heart failure, as assessed by surrogate markers as EF and NTproBNP.