Prevalence of elevated lipoprotein(a) in Indian patients presenting with acute coronary syndrome: a large tertiary care cohort study

Background

Lipoprotein(a) [Lp(a)] is a genetically determined and independent risk factor for atherosclerotic cardiovascular disease (ASCVD). Current European and Indian guidelines recommend at least one lifetime measurement, with levels >50 mg/dL associated with higher cardiovascular risk . However, data regarding the burden of elevated Lp(a) among Indian patients presenting with acute coronary syndrome (ACS) are limited.

Purpose

To determine the prevalence of elevated Lp(a) (>50 mg/dL) in Indian patients hospitalized with ACS and to evaluate differences according to age groups.

Methods

This retrospective cross-sectional study included 1,540 consecutive patients admitted with ACS to a tertiary care center in India. Serum Lp(a) was measured using an immuno-turbidimetric method. Elevated Lp(a) was defined as >50 mg/dL. Patients were stratified by age into younger (<60 years) and older (≥60 years) groups. Continuous variables are presented as mean ± SD or median (interquartile range [IQR]) as appropriate. Prevalence estimates are reported with 95% confidence intervals (CI). Findings were interpreted in the context of a previously reported subset of 1,021 patients from the same cohort in which elevated Lp(a) showed significant association with angiographic severity (Gensini score).

Results

The cohort (n=1,540) had a mean Lp(a) of 44.7 ± 40.9 mg/dL and a median of 31.9 mg/dL (IQR: 14.4–64.3 mg/dL).

Elevated Lp(a) (>50 mg/dL) was present in 34.7% (535/1,540) of patients. Additionally, 22.7% (349/1,540) had Lp(a) levels >70 mg/dL, representing a substantial very high-risk subgroup.

When the patients were divided by age, high Lp(a) levels were common in both younger (<60 years, n=749) and older (≥60 years, n=791) groups., with a numerically higher burden observed in patients <60 years compared with those ≥60 years. This difference was statistically significant.

Conclusion

Approximately one-third of Indian patients presenting with ACS have elevated Lp(a), with nearly one-fifth exhibiting very high levels (>70 mg/dL). The high prevalence of elevated Lp(a) in patients <60 years highlights the possible contribution of inherited lipoprotein risk in younger individuals presenting with ACS. The high prevalence of elevated Lp(a) supports consideration of systematic Lp(a) assessment in patients with established ASCVD.