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Impact of Lipoprotein(a) Levels on Cardiovascular Risk Estimation

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Abstract

Introduction

A new cardiovascular risk (CVR) calculator that incorporates Lipoprotein(a) [Lp(a)] levels has recently been designed.

Aims

To estimate CVR using the new score and to identify the reduction in low-density lipoprotein cholesterol (LDL-C) or systolic blood pressure (SBP) necessary to balance the risk attributable to Lp(a).

Methods

CVR throughout life and at 10 years was estimated with the new score in patients in primary prevention, both considering and not considering the value of Lp(a). When the estimated risk considering Lp(a) levels exceeded the baseline risk, the reduction in LDL-C levels or SBP necessary to balance the risk attributable to Lp(a) was calculated.

Results

In total, 671 patients (mean age 54.2 years, 47.2% women) were included. Globally, 22.7% of the population had high Lp(a) values (> 50 mg/dL or > 125 nmol/L). When calculating CVR throughout life and considering the Lp(a) value, the global risk increased in 66.7% of cases (median 19.3%). Similar results were observed when we assessed the 10-year risk. The risk associated with Lp(a) could be completely compensated by decreasing LDL-C (average 21 mg/dL) or SBP (average 6.3 mmHg) in 79.2% and 74.7% of cases, respectively.

Conclusion

When calculating the CVR with the new score, two-thirds and one-third of the population were bidirectionally recategorized as ‘up’ or ‘down,’ respectively. The decrease in LDL-C or SBP mitigated the increased risk caused by Lp(a) levels across a substantial proportion of patients.

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Authors and Affiliations

  1. Department of Cardiology, Hospital Italiano de Buenos Aires, Perón 4190, C1199ABB, Ciudad Autónoma de Buenos Aires, Argentina

    Walter Masson, Leandro Barbagelata & Daniel Siniawski

  2. Argentine Group for the Study of Lp(a) [GAELp(a)], Buenos Aires, Argentina

    Walter Masson, Pablo Corral & Augusto Lavalle-Cobo

  3. Lezica Cardiovascular Institute, San Isidro, Argentina

    Gabriel Waisman & Melina Huerin

  4. Faculty of Medicine, FASTA University, Mar del Plata, Argentina

    Pablo Corral

  5. Otamendi Sanatorium, Buenos Aires, Argentina

    Augusto Lavalle-Cobo

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  1. Walter Masson
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Correspondence to Walter Masson.

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Funding

The authors did not receive support from any organization for the submitted work.

Conflicts of interest

The authors have no relevant financial or non-financial interests to disclose.

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The data underlying this article are available in the article.

Author contributions

WM and DS participated in the conception and design of the research. WM, GW, MH, LB, DS, ALC and PC participated in the data collection. WM and DS performed the statistical analysis. WM, ALC, PC and DS drafted the manuscript. All authors performed a critical review of the final document. All authors have read and agreed to the published version of the manuscript.

Ethical considerations

The study was conducted in accordance with the recommendations for medical research. Ethical approval was waived by the local Ethics Committee of the Italian Hospital of Buenos Aires (approval number 6951) in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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Masson, W., Waisman, G., Corral, P. et al. Impact of Lipoprotein(a) Levels on Cardiovascular Risk Estimation. High Blood Press Cardiovasc Prev (2024). https://doi.org/10.1007/s40292-024-00649-x

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