Each Lp(a) tertile increase brings a premature heart attack 0.83 years earlier and adds 8 points to Gensini score, RELACS study of 774 ACS patients finds (Nutr Metab Cardiovasc Dis 2025)

Original title: Role of LipoprotEin(a) in CardiovascuLar diseases and premature acute coronary syndromes (RELACS study): Impact of Lipoprotein(a) levels on the premature coronary event and the severity of coronary artery disease

Nutr Metab Cardiovasc Dis · 24 December 2024 · 7

Cesaro A, Acerbo V, Scialla F, Scherillo G, De Michele G, Panico D, Porcelli G, de Sio V, Capolongo A, Sperlongano S, Ruggiero A, Gragnano F et al.

The RELACS study, a single-centre prospective observational study, enrolled 774 consecutive acute coronary syndrome (ACS) patients (mean age 63.2 years, 78% male; 40.1% STEMI, 46.9% NSTEMI, 13% unstable angina; median Lp(a) 21.85 mg/dL) to investigate whether Lp(a) level predicts the age of first coronary event and disease complexity. Higher Lp(a) was linked to a younger age at first coronary event (B coefficient -0.83, P = 0.002), and correlated positively with both Gensini score (r = 0.16, P = 0.011) and SYNTAX score (r = 0.14, P = 0.004); each Lp(a) tertile increase corresponded to an 8.01-point rise in Gensini score (P = 0.019) and a 2.92-point rise in SYNTAX score (P < 0.001). The authors conclude elevated Lp(a) is associated with both earlier-onset and more complex coronary artery disease in ACS patients, positioning it as a critical driver of early atherogenesis that may warrant more aggressive primary-prevention lipid-lowering.

Original abstract

Background And Aims: Lipoprotein(a) [Lp(a)] emerging as a significant risk factor for coronary artery disease (CAD). However, the role and the impact of Lp(a) in the early formation and progression of complex CAD remains unclear. This study aimed to investigate the impact of Lp(a) levels on the age of first acute coronary events and CAD severity in acute coronary syndrome (ACS) patients.

Methods And Results: The RELACS study, a single-center prospective observational study that included 774 consecutive ACS patients. Lp(a) levels were measured and stratified into tertiles. Primary endpoint was the correlation between Lp(a) levels and the age of first acute coronary event. Secondary endpoint was correlation between Lp(a) levels and CAD complexity (SYNTAX I and Gensini scores). The mean (SD) age was 63.2 (12.6) years and 603 (78 %) were males. The clinical presentations included 40.1 % of patients with STEMI, 46.9 % with NSTEMI, and 13 % with unstable angina. Median baseline Lp(a) level was 21.85 mg/dL. Higher Lp(a) levels were linked to a younger age of the first coronary event (B coefficient -0.83, p = 0.002). Positive correlations were found between Lp(a) levels and Gensini (r = 0.16, p = 0.011) and SYNTAX scores (r = 0.14, p = 0.004). Each tertile increase in Lp(a) corresponded to an 8.01-point increase in Gensini score (p = 0.019) and a 2.92-point increase in SYNTAX score (p < 0.001).

Conclusions: Elevated Lp(a) levels are associated with earlier onset and greater complexity of CAD in ACS patients. These findings suggest Lp(a) is a critical risk factor for early atherogenesis and may require aggressive lipid-lowering strategies in primary prevention settings.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.