AUTHOR=Vinci Pierandrea , Fiotti Nicola , Panizon Emiliano , Tosoni Letizia Maria , Cerrato Carla , Pellicori Federica , Pirulli Alessia , Altamura Nicola , Schincariol Paolo , Di Girolamo Filippo Giorgio , Biolo Gianni 

TITLE=Epidemiology of atherosclerotic cardiovascular disease in polygenic hypercholesterolemia with or without high lipoprotein(a) levels

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2024

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1272288

DOI=10.3389/fcvm.2023.1272288

ISSN=2297-055X

ABSTRACT=Background and Aims: Epidemiology of atherosclerotic cardiovascular disease might be different in patients with polygenic hypercholesterolemia plus high levels (≥30 mg/dL) of Lp(a) (H-Lpa) than in those with polygenic hypercholesterolemia alone (H-LDL). We compared the incidence of peripheral artery disease (PAD), coronary artery disease (CAD), and cerebrovascular disease (CVD) in patients with H-Lpa and in H-LDL. Methods: retrospective analysis of demographics, risk factors, vascular events, therapy and lipid profile in outpatients clinical data. Inclusion criteria was adult age, and diagnosis of polygenic hypercholesterolemia, and both indication and availability for Lp(a) measurement. Results: medical records of 258 patients with H-Lpa and 290 H-LDL were reviewed for occurrence of vascular events. The median duration of follow-up was 10 years (IQR 3-16). In spite of a similar reduction of LDL cholesterol, vascular events occurred more frequently, and approximately 7 years earlier (P=0.024) in patients with H-Lpa than in H-LDL (HR 1.96 1.21-3.17, P= 0.006). The difference was around 10 years for acute events (TIA, Stroke, acute coronary events) and one year for chronic ones (P=0.023 and 0.525, respectively). Occurrence of acute CAD was higher in H-Lpa men (HR 3.1, 95% CI 1.2-7.9, P= 0.007) while, among women, PAD was observed exclusively in H-Lpa subjects with smoking habits (P=0.009). Conclusions: patients with high Lp(a) levels suffer from a larger and earlier burden of the disease compared to those with polygenic hypercholesterolemia alone. These patients are at higher risk of CAD if men and of PAD if women.