Clinical Relevance of Lipoprotein(a) in Young Acute Myocardial Infarction: STEMI vs. NSTEMI

TL;DR

High levels of Lp(a) are linked to heart disease in young people, especially those with NSTEMI heart attacks.

Contribution

The study identifies Lp(a) as a significant biomarker for multivessel disease in young NSTEMI patients.

Findings

Elevated Lp(a) levels are significantly more common in young AMI patients than in healthy controls.

High Lp(a) is strongly associated with multivessel coronary disease in NSTEMI cases.

Lp(a)'s impact in STEMI is weaker and influenced by other factors like diabetes and LDL cholesterol.

Abstract

Background: The incidence of acute myocardial infarction (AMI) in young adults has been steadily rising, emphasizing the need for new biomarkers to improve risk stratification. Lipoprotein(a) (Lp(a)), a genetically determined lipoprotein with pro-atherogenic and pro-thrombotic properties, has gained increasing attention in this context. Methods: We evaluated serum Lp(a) levels in young patients with AMI and compared them with healthy controls. Associations between elevated Lp(a) levels (≥30 mg/dL) and coronary artery disease patterns were analyzed separately for STEMI and NSTEMI presentations. Results: Elevated Lp(a) levels were significantly more common in young patients with AMI compared with healthy controls. Importantly, Lp(a) ≥ 30 mg/dL was strongly associated with multivessel coronary artery disease in NSTEMI, conferring more than a fourfold increased risk. In STEMI, the effect was weaker and largely influenced by concomitant factors such as diabetes and elevated LDL cholesterol. Conclusions: These findings highlight key pathophysiological differences between infarct phenotypes and position Lp(a) as a particularly relevant biomarker in young NSTEMI patients. The systematic assessment of Lp(a) may enhance coronary risk stratification and support more tailored secondary prevention strategies.

Figures