Lipoprotein(a) as a predictor of major adverse cardiovascular events in patients with very premature (≤40 years) acute coronary syndrome: long-term follow-up of the STudy of eArly Myocardial INfArction study

Loukianos S Rallidis; Sofia-Panagiota Giannakopoulou; Christos Kotakos; Stylianos Armylagos; Stylianos L Rallidis; Eleni P Stathopoulou; Konstantinos A Papathanasiou; Demosthenes Panagiotakos

doi:10.1097/MCA.0000000000001627

Lipoprotein(a) as a predictor of major adverse cardiovascular events in patients with very premature (≤40 years) acute coronary syndrome: long-term follow-up of the STudy of eArly Myocardial INfArction study

Coron Artery Dis. 2026 Mar 9. doi: 10.1097/MCA.0000000000001627. Online ahead of print.

Authors

Loukianos S Rallidis¹, Sofia-Panagiota Giannakopoulou², Christos Kotakos³, Stylianos Armylagos¹, Stylianos L Rallidis⁴, Eleni P Stathopoulou⁵, Konstantinos A Papathanasiou¹, Demosthenes Panagiotakos²

Affiliations

¹ Second Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON.
² Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University.
³ Cardiology Department, 251 Hellenic Air Force General Hospital, Athens, Greece.
⁴ Biomedical Sciences, Medical School, University of Nicosia, Nicosia, Cyprus.
⁵ Clinical Biochemistry Unit, University General Hospital ATTIKON, Athens, Greece.

PMID: 41797494
DOI: 10.1097/MCA.0000000000001627

Abstract

Background: Lipoprotein(a) [Lp(a)] is a causal risk factor for cardiovascular disease, and it is particularly associated with premature acute coronary syndrome (ACS). We investigated whether elevated Lp(a) can predict recurrent cardiovascular events in patients who experienced their first ACS less than or equal to 40 years of age.

Methods: Within the STudy of eArly Myocardial INfArction registry, we recruited 405 consecutive patients who survived their first ACS less than or equal to 40 years of age; of them 378 had complete follow-up data. Clinical endpoint was the development of major adverse cardiovascular events (MACE; i.e. cardiac death, readmission for ACS or malignant ventricular arrhythmias, ischemic stroke, or coronary revascularization due to clinical deterioration). Multi-adjusted Cox regression was used to assess the association between Lp(a) and first recurrent MACE risk.

Results: Of the 378 ACS survivors (33.7 ± 4.3 years), 139 (36.8%) experienced a MACE over a median 8-year (5.2-12.5 years) follow-up. Elevated Lp(a) showed a borderline independent association with higher recurrent MACE [hazard ratio per 1 mg/dl: 1.004, 95% confidence interval (CI): 0.999-1.009, P = 0.051]. Moreover, patients with baseline Lp(a) levels greater than or equal to 50 mg/dl had 82.6% higher risk of MACE as compared with those below (hazard ratio 1.826, 95% CI: 1.141-2.925, P = 0.012); similarly, patients with Lp(a) ≥ 70 mg/dl had 118% higher risk as compared with those below (hazard ratio 2.180, 95% CI: 1.330-3.573, P = 0.002).

Conclusion: Elevated Lp(a) concentrations demonstrate an independent association with recurrent MACE among very young ACS survivors. Until targeted Lp(a)-lowering treatments become clinically available, an aggressive lipid-lowering approach may be warranted to partially attenuate Lp(a)-related residual cardiovascular risk.

Keywords: acute coronary syndrome; lipoprotein(a); premature coronary artery disease; young.