ESC Congress 2024: Experts call for routine screening of Lipoprotein(a) in cardiovascular health
A series of groundbreaking studies from Poland have shed new light on the prevalence and impact of lipoprotein(a) [Lp(a)] on cardiovascular health, prompting calls for routine measurement of this important biomarker.
The research, presented at the European Society of Cardiology (ESC) Congress in London and published in Progress in Cardiovascular Diseases [1] and Archives of Medical Sciences on 29 August 2024, reveals that elevated Lp(a) levels are more common than previously thought and play a significant role in the development of heart and blood vessel diseases.
Professor Maciej Banach of the Medical University of Lodz.
Prevalence of elevated Lp(a)
The studies, conducted across three different patient groups in Poland, found that elevated Lp(a) levels were present in 20-34% of individuals receiving preventive care or being treated for cardiovascular diseases. This high prevalence suggests that as many as six million adults in Poland, with a population of approximately 38.5 million, may have high Lp(a) levels.
Professor Maciej Banach of the Medical University of Lodz, who led one of the studies, emphasised the significance of these findings: “These results show that Lp(a) is highly prevalent in Poland, which is the eighth most populous country in the EU. They suggest that Lp(a) should be measured more routinely than happens at present.”
The importance of Lp(a) screening
Lp(a) is a complex of fats and proteins that circulates in the bloodstream. High levels of Lp(a) have been linked to an increased risk of atherosclerosis, blood clots, and consequently, heart attacks and strokes. Unlike other cardiovascular risk factors, Lp(a) levels are primarily determined by genetics, making it a unique and important marker for assessing heart disease risk.
The research presented at the ESC Congress highlights the need for more widespread Lp(a) screening, particularly in high-risk populations. Prof. Banach and his colleagues argue that everyone should have their Lp(a) levels measured at least once in their lifetime, with more frequent testing for those with premature myocardial infarction or familial hypercholesterolaemia.
Link to atherosclerosis progression
One of the studies, the STAR-Lp(a) study, led by Associate Professor Michal Chudzik, examined the relationship between elevated Lp(a) levels and the risk of developing atherosclerosis. The researchers found a direct link between Lp(a) and the progression of atherosclerosis, as measured by the coronary artery calcium (CAC) score.
Prof. Banach reported: “For every 10 mg/dL increase in Lp(a), the CAC score increases by 16 points. What is more, in those with Lp(a) of 50 mg/dl or less, the chance of having a CAC Score of 0, meaning there was no sign of coronary artery disease, was 2.3 times higher than in those with elevated levels of Lp(a).”
These findings suggest that patients with elevated Lp(a) levels should be considered for coronary CT scans to assess their risk of cardiovascular disease more accurately.
Impact on high-risk patients
The third study, presented by Associate Professor Krzysztof Dyrbuś from the Silesian Center for Heart Diseases, focused on patients with very high and extremely high risk of cardiovascular disease. The researchers found that 27% of patients with established atherosclerotic cardiovascular disease (ASCVD) had Lp(a) levels above 30 mg/dL.
Particularly high prevalence was observed in patients with chronic coronary syndrome (32%), those who had undergone percutaneous coronary intervention (32%), and patients with a previous heart attack (34%). These results highlight the additional risk that elevated Lp(a) levels pose to patients already at high risk of cardiovascular events.
Implications for treatment
The studies also provided insights into potential treatment strategies for patients with high Lp(a) levels. Prof. Banach noted that PCSK9 inhibitors were associated with a significant reduction in Lp(a) levels of about 45%. This finding suggests that these drugs may offer a therapeutic option for managing high Lp(a) levels in addition to their known effects on LDL cholesterol.
Additionally, the research raised questions about the potential use of aspirin in patients with elevated Lp(a) levels, as a higher platelet count was found to be significantly related to elevated Lp(a). However, the researchers cautioned that more research is needed before any changes to current treatment recommendations can be made.
Conclusion
The findings from these Polish studies underscore the importance of Lp(a) as a risk factor for cardiovascular disease and highlight the need for more routine measurement of this biomarker. As our understanding of Lp(a)’s role in heart health continues to grow, it is likely that Lp(a) testing will become an increasingly important part of cardiovascular risk assessment and management strategies.
The research not only provides valuable insights into the prevalence of elevated Lp(a) in a large European population but also offers a compelling case for incorporating Lp(a) screening into routine cardiovascular care. As further studies investigate potential treatments and management strategies for high Lp(a) levels, this biomarker may become a key target in the ongoing fight against heart disease.
Reference:
- Sosnowska, B., Lewek, J., Adach, W., et. al. (2024). The Prevalence, Patients’ Characteristics, and Hyper-Lp(a)-emia Risk Factors in the Polish Population. The First Results from the PMMHRI-Lp(a) Registry. Progress in Cardiovascular Diseases. https://doi.org/10.1016/j.pcad.2024.08.004
