Lipoprotein (a) is a predictor of non-achievement of LDL-C goals in patients with chronic heart disease

Introduction and objectives

Lipoprotein (a) [Lp(a)] concentration influences serum low-density lipoprotein cholesterol (LDL-C) levels. How it influences the achievement of LDL-C targets established in the guidelines is not well studied. Our aim was to know the prevalence of elevated Lp(a) levels in patients with coronary artery disease (CAD), and to assess its influence on the achievement of LDL-C targets.

Method

We conducted a cross-sectional study in a Cardiology department in Spain. A total of 870 patients with stable CAD had their lipid profile determined, including Lp(a). Patients were stratified into two groups according to Lp(a) >50 mg/dL and Lp(a) ≤50 mg/dL. The association of Lp(a) >50 mg/dL with achievement of LDL-C targets was assessed by logistic regression analysis.

Results

The prevalence of Lp(a) >50 mg/dL was 30.8%. Patients with Lp(a) >50 mg/dL had higher baseline (142.30 ± 47.54 mg/dL vs 130.47 ± 40.75 mg/dL; p = 0.0001) and current (72.91 ± 26.44 mg/dL vs 64.72 ± 25.30 mg/dL; p = 0.0001), despite the fact that they were treated with more high-potency statins (77.2% vs 70.9%; p = 0.058) and more combination lipid-lowering therapy (LLT) (37.7% vs 25.7%; p = 0.001). The proportion of patients achieving target LDL-C was lower in those with Lp(a) >50 mg/dL. Independent predictors of having elevated Lp(a) levels >50 mg/dL were the use of high-potency statins (OR 1.5; 95% CI 1.08−2.14), combination LLT with ezetimibe (OR 2.0; 95% CI 1.45−2.73) and failure to achieve a LDL-C ≤55 mg/dL (OR 2.3; 95% CI 1.63−3.23).

Conclusions

Elevated Lp(a) levels influence LDL-C levels and hinder the achievement of targets in patients at very high cardiovascular risk. New drugs that act directly on Lp(a) are needed in these patients.