Risk modification role of opportunistic screening of lipoprotein(a) at first acute coronary syndrome admission in patients under 65 years old

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction There is a strong association between lipoprotein(a) (Lp(a)) and atherosclerotic cardiovascular disease (ASCVD). Recent guidelines recommend its measure once in each adults’ lifetime, but the moment remains undefined. Moreover, little is known about Lp(a) in the acute setting. Purpose To describe Lp(a) levels in young patients (under 65) affected by its first acute coronary syndrome (ACS) as part of the standard evaluation during hospitalization and how it can affect lipid residual risk stratification. Methods We conducted a descriptive and retrospective study involving 51 patients under 65 years old admitted to hospital between July 2022 and October 2022, for ACS, irrespective of the onset of symptoms (unstable angina, myocardial infarction with or without ST-segment elevation (STEMI, NSTEMI). We tested Lp(a), apolipoprotein B (ApoB), low and high-density lipoprotein cholesterol (LDLc, HDLc), triglycerides (TG) and glycated haemoglobin (HbA1c), in those patients. Results We included 51 patients in our study. 76,5% were male. Mean age was 56,1 years (± 7,34). The distribution of risk factors was: smoking 68,6%, hypertension 52,9%, diabetes 31,4%, dyslipidaemia 43,1%. 30 patients had STEMI (58,8%), 17 NSTEMI (33,3%); 4 unstable angina. Immediate percutaneous coronary intervention was made in 33 patients (64,7%). Mean LVEF was 55,19% (± 9,4). Mean high-sensivity troponin I (hsTnI) peak was 47648,14 ng/L (± 71365). 13 patients had Lp(a) >50 mg/dL (25,5%), including 2 patients with Lp(a) levels above 180 mg/dL. The rest of the lipid profile is shown in Table 1. Conclusion In our sample of young ACS patients, one of each four patients has Lp(a) levels above 50 mg/dL, which confers a higher risk for ASCVD. We consider screening for Lp(a) in ACS as an opportunity to redefine cardiovascular risk and intensify lipid lowering therapies during follow-up.