Lipid risk profile in ACS in young women: contribution of Lp(a) measurement: ancillary analysis of the WAMIF study
S Manzo-Silberman, A Bellemain-Appaix, R Khani-Bittar, S Rouanet, F Coururaud, N Braham-Ghedira, A Gompel, S Uhry, H Eltchaninoff, T Bergot, K Brochard, P Motreff, G Montalescot, M GilardAbstract
Background
Young women presenting with acute coronary syndrome (ACS) represent a distinct clinical phenotype with heterogeneous mechanisms: premature atherosclerosis and non-obstructive coronary disease. In the WAMIF study (Women with Acute Myocardial Infarction), a French national multicenter cohort of women under 50 years, 15.6% had no significant coronary stenosis. Lipoprotein(a) [Lp(a)], a genetically determined atherogenic lipoprotein, is associated with long-term cardiovascular risk and may improve risk stratification when combined with LDL cholesterol and high-sensitivity C-reactive protein (hs-CRP). To date, there are no data on the evaluation of these biomarkers, particularly the lipid profile, in a population of young women in the acute phase of myocardial infarction.
Purpose
To characterize Lp(a) levels in women <50 years presenting with myocardial infarction (MI) and to explore their distribution across coronary disease severity as well as within combined lipid-inflammatory biomarker profiles.
Methods
This is a post-hoc analysis of the prospective, observational WAMIF cohort including women <50 years hospitalized for ACS. Lp(a) levels were measured from the centralized biobank. LDL cholesterol and hs-CRP were previously collected. Elevated Lp(a) was defined according to established high-risk thresholds. High Lp(a) categories and a combined lipid-inflammatory biomarker burden, defined by the number of elevated biomarkers, were described according to atherosclerosis status and coronary disease severity.
Results
Among 314 women (median age: 44.0 years [IQR: 39.0–47.0]), 60.8% had ST-segment elevation myocardial infarction (STEMI). The median LDL-C level was 1.21 g/L (IQR: 0.9–1.46), with 22.3% of patients having a level greater than 1.5 g/L. The median hs-CRP level was 6 mg/L (IQR: 3.0–12.3), with 51.5% of patients having a level greater than 5 mg/L. Preliminary analyses show that elevated Lp(a) levels are common in this population, with 21.7% of patients having Lp(a) levels ≥ 0.50 g/L. Elevated Lp(a) levels appear to be associated with a greater atherosclerotic burden, with elevated Lp(a) levels observed in 23.5% of patients with atherosclerosis, compared to 12.8% in those without. A progressive increase in the prevalence of atherosclerosis was observed with increasing biomarker burden, from patients without elevated biomarkers to those with at least two elevated biomarkers (Figure 1). The extent of coronary artery disease also worsens with the cumulative effect of elevated biomarkers (Figure 2).
Conclusion
We report the first descriptive analyses in this population suggesting that higher Lp(a) levels and an increased burden of combined lipid and inflammatory biomarkers are more frequently observed in patients with more extensive atherosclerosis. These findings support the measurement of Lp(a) in young women with ACS and could help identify candidates for treatments aimed at reducing Lp(a).Biomarkers and extent of CAD