Distribution of lipoprotein(a) and its association with atherosclerotic cardiovascular disease in a large real-world Polish cohort.

BACKGROUND: Lipoprotein(a) [Lp(a)] is an established cardiovascular risk factor, but large-scale contemporary real-world data from Poland remain limited. OBJECTIVE: To assess the distribution of Lp(a) levels, their associations with cardiovascular conditions, and their relationship with conventional lipid parameters in adults undergoing testing within the LUX MED network in Poland. METHODS: This retrospective observational study included 23,654 adults with Lp(a) measurements reported in nmol/L. Atherosclerotic cardiovascular disease (ASCVD) included coronary artery disease (CAD), previous myocardial infarction (MI), or previous stroke/transient ischemic attack (TIA). Multivariable logistic regression models for the ASCVD, CAD, previous MI, and stroke/TIA were adjusted for age, sex, body mass index (BMI), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides. RESULTS: Median Lp(a) was 12.7 nmol/L (IQR, 7.0-47.0). Lp(a) levels showed weak positive correlations with age, BMI, total cholesterol, and LDL-C, with no meaningful correlation with HDL-C. In fully adjusted models, ln(Lp(a) + 1) was independently associated with the ASCVD (OR 1.15, 95% CI 1.07-1.24), CAD (OR 1.21, 95% CI 1.12-1.32), and previous MI (OR 1.78, 95% CI 1.31-2.41), but not with stroke/TIA (OR 0.97, 95% CI 0.86-1.09). Compared with Lp(a) <62 nmol/L, levels ≥105 nmol/L were associated with the ASCVD, CAD, and previous MI. Associations for ASCVD and CAD were consistent in sensitivity analyses, including up to the entire cohort and at the ≥125 nmol/L threshold, and among patients with LDL-C <70 mg/dL. CONCLUSION: In this large real-world Polish cohort, elevated Lp(a) levels were common and independently associated with major manifestations of ASCVD, supporting measurement of Lp(a) as part of comprehensive lipid evaluation.