Elevated lipoprotein(a) is highly prevalent in ischaemic heart failure with reduced ejection fraction and shows sex-related differences

Background

Lipoprotein(a) is a genetically determined lipoprotein strongly associated with atherosclerotic cardiovascular disease. Its distribution and potential clinical relevance in patients with heart failure with reduced ejection fraction (HFrEF), particularly in relation to ischaemic aetiology and sex differences, remain incompletely defined.

Purpose

To evaluate the prevalence of elevated lipoprotein(a) and its association with cardiometabolic comorbidities and sex in patients with HFrEF.

Methods

A total of 212 consecutive patients with chronic HFrEF were included. Clinical characteristics and cardiovascular comorbidities were systematically recorded. Lipoprotein(a) concentrations were measured in nmol/L using standardised laboratory methods, with values >75 nmol/L considered elevated. The prevalence of hypertension, dyslipidaemia, ischaemic heart disease and atrial fibrillation was assessed. Patients with ischaemic heart disease were considered to have concomitant hypertension and dyslipidaemia.

Results

The study population comprised 133 women (62.7%) and 79 men (37.3%), aged 42–87 years. Hypertension was present in 185 patients (87.3%), dyslipidaemia in 170 (80.2%), ischaemic heart disease in 72 (34.0%) and atrial fibrillation in 114 (53.8%).

Overall, elevated lipoprotein(a) levels (>75 nmol/L) were observed in 49 patients (23.1%). Elevated lipoprotein(a) was more frequently detected in women than in men (approximately 27% vs. 17%).

Among patients with ischaemic heart disease, elevated lipoprotein(a) was present in approximately one-third of cases, with no marked sex-related differences within this subgroup.

Conclusions

Patients with heart failure with reduced ejection fraction demonstrate a substantial burden of cardiometabolic comorbidities, including a notable prevalence of elevated lipoprotein(a). Elevated lipoprotein(a) is more frequently observed in women and is commonly present among patients with ischaemic aetiology. These findings support a contributory role of lipoprotein(a) in the atherosclerotic substrate of HFrEF and highlight its potential relevance for refined phenotyping and cardiovascular risk stratification.