OBJECTIVES: Elevated Lp(a) is independently and causally associated with increased risk of atherosclerotic cardiovascular disease (ASCVD). This real-world analysis is aimed to compare the characteristics of ASCVD patients with elevated (≥50 mg/dL) or normal (<30 mg/dL) Lp(a) levels, and to assess the clinical impact of elevated Lp(a) on the occurrence of future cardiovascular events.

METHODS: This retrospective cohort study investigated patients with available Lp(a) measurement and established ASCVD found between 2012 and March 2023 in laboratory and administrative databases of a pool of Italian healthcare entities. Index-date was defined as the time of the first detected ASCVD hospitalization during the observation period. After stratification by elevated and normal Lp(a) levels, the groups were compared for demographics, clinical characteristics, comorbidities, medications at baseline, and occurrence of cardiovascular events at 2-year follow-up.

RESULTS: At index-date, patients with elevated Lp(a) levels (N=719) compared to those with normal levels (N=2585) were younger (67.5±12.9 vs 69.2±13.4 years, p<0.010), had similar sex distribution (nearly 70% males), higher likelihood of ischemic heart disease as index ASCVD hospitalization (73.9%, vs 68.5% p<0.010) and higher rates of previous atrial fibrillation. Patients with elevated Lp(a) levels showed a larger utilization of lipid-lowering therapies and antihypertensives, and had higher LDL-cholesterol levels (107.1±42.0 vs 99.5±39.4 mg/dL, p<0.001). At 2 years of follow-up, the rates per 100 person-year for ASCVD-events were higher among patients with elevated Lp(a) than those with normal levels (9.7 vs 5.8, p<0.001).

CONCLUSIONS: This real-world analysis showed that ASCVD patients with elevated Lp(a) levels have an increased risk of experiencing a second ASCVD event within two years from the first event. These findings corroborate the importance of Lp(a) testing/screening to implement more effective cardiovascular risk assessment and prevention of future events in high-risk ASCVD patients, which in turn might alleviate the economic burden sustained by the healthcare system for disease management.