# Lp(a) in daily clinical routine: risk-factor for both cardiovascular events and heart-failure? A retrospective analysis of the Luebeck Lp(a) heart-failure (HF) registry in patients after myocardial infarction

## TL;DR

This study examines the role of Lp(a) in heart failure and cardiovascular disease by analyzing data from patients who had heart attacks, finding that Lp(a) levels are rarely measured and do not correlate with heart failure markers.

## Contribution

The study provides new insights into the underutilization of Lp(a) testing in high-risk cardiovascular patients and its lack of correlation with heart failure indicators.

## Key findings

- Lp(a) was assessed in only a minority of patients with heart attacks.
- Lp(a) levels did not correlate with heart failure markers like ejection fraction or NTproBNP.
- Statin pretreatment was more common in NSTEMI patients compared to STEMI patients.

## Abstract

Atherosclerotic cardiovascular disease (ASCVD) is a major health burden being the leading cause of death in Europe. Lipoprotein (a) (Lp(a)) is an important risk factor for CV events reflected by the 2019 ESC recommendation of a once in a lifetime Lp(a) measurement. Furthermore, heart-failure (HF) is the number one diagnosis for hospital admission in Germany and Europe. HF and ASCVD share common well-known risk factors, e.g. diabetes, obesity and hypertension. So far, there is scarcity of data regarding the relationship between Lp(a) and HF. We hypothesized that Lp(a) might be elevated in a high-risk ASCVD patient collective and that there might also be an association with heart-failure.

The Luebeck Lp(a) HF registry is a combined retrospective/prospective single-center, all-comers registry which investigates the relationship between Lp(a) and HF. The retrospective analysis reported here, comprises patients who were admitted to our heart-catheterization laboratory in the year 2021 due to ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI).

We found that Lp(a) was assessed only in a minority of patients presenting with STEMI (33 %) and NSTEMI (14.6 %), p < 0.001. There was no relationship between Lp(a) level and ejection fraction (EF) or NTproBNP as surrogate markers for HF, respectively. Statin pretreatment was more frequent in patients with NSTEMI (31.1 %) compared to STEMI patients (11.3 %), p < 0.001.

Despite ESC recommendation, routine Lp(a) measurement is only rarely performed even in a high-risk patient collective. In patients with MI, we could retrospectively not observe a correlation between Lp(a) levels and heart failure, as assessed by surrogate markers as EF and NTproBNP.

Image 1

•Lp(a) was rarely measured in clinical practice in high-risk ASCD patients.•LV-EF and NTproBNP did not correlate with Lp(a) levels.•Statin pretreatment was more frequent in STEMI compared to NSTEMI patients.

Lp(a) was rarely measured in clinical practice in high-risk ASCD patients.

LV-EF and NTproBNP did not correlate with Lp(a) levels.

Statin pretreatment was more frequent in STEMI compared to NSTEMI patients.