Lp(a) and PCSK9 are markedly elevated in first ACS but don't track coronary severity, Indian cohort of 160 (Int J Cardiol Cardiovasc Risk Prev 2026)

Original title: A study of extended lipid profile in patients with acute coronary syndrome: Focus on Lipoprotein(a) and PCSK9

Int J Cardiol Cardiovasc Risk Prev · 4 December 2025 · 6

Kumar P, Prajapathi S, Singh A, Pradhan A, Shukla A, Bhandari M, Sharma A, Vishwakarma P, Chaudhary G, Chandra S, Sethi R, Dwivedi S et al.

Single-center study of 160 patients with first-episode acute coronary syndrome (ACS, mean age 55.7, 73.1% male, most frequently STEMI at 53.7%) and 40 age-matched healthy controls, all lipid-lowering-therapy-naive, comparing Lp(a) and PCSK9 levels and testing their relationship with SYNTAX score-defined coronary severity. Median SYNTAX score was 19.4. Lp(a) (38.9 vs 15.9 mg/dL) and PCSK9 (272.3 vs 169.6 ng/mL) were markedly higher in ACS patients than controls (both p<0.001), and LDL-C correlated modestly with Lp(a) (r=0.163, p=0.040). Neither Lp(a) nor PCSK9 correlated with SYNTAX score, though higher SYNTAX scores were associated with more extensive multivessel disease. The authors conclude Lp(a) and PCSK9 are markedly elevated in first-episode ACS but do not reflect angiographic disease complexity, suggesting their clinical value lies more in overall cardiovascular risk assessment than in predicting anatomical severity.

Original abstract

Background: Lipoprotein(a) [Lp(a)] and PCSK9 are emerging lipid biomarkers implicated in atherogenesis and residual cardiovascular risk, but their relationship with coronary disease complexity in acute coronary syndrome (ACS) is unclear. This study evaluates their serum levels in first-episode ACS patients versus controls and explores their relationship with SYNTAX score-defined coronary severity.

Methods: This single-centre observational study enrolled 160 patients presenting with their first episode of ACS (aged 18-75) and 40 age-matched healthy controls. All participants were free from lipid-lowering therapy and major comorbidities. Fasting serum samples were collected to measure the standard lipid profile, Lp(a), and PCSK9 levels. The severity of coronary artery disease was quantified using the SYNTAX score after coronary angiography.

Results: The ACS cohort (mean age 55.7 years; 73.1 % male) most frequently presented with STEMI (53.7 %). Traditional risk factors included smoking/tobacco use (48.8 %), diabetes (40.0 %), and hypertension (38.1 %). Median SYNTAX score was 19.4. Compared with controls, ACS patients had significantly lower HDL-C and higher LDL/HDL and cholesterol/HDL ratios. Lp(a) (38.9 vs. 15.9 mg/dL, p < 0.001) and PCSK9 (272.3 vs. 169.6 ng/mL, p < 0.001) were markedly elevated in ACS patients. Neither Lp(a) nor PCSK9 correlated with SYNTAX score. LDL-C showed a modest positive correlation with Lp(a) (r = 0.163, p = 0.040). Higher SYNTAX scores were associated with more extensive multivessel disease.

Conclusion: Patients with ACS exhibited significantly higher Lp(a) and PCSK9 levels compared with healthy controls, but these biomarkers did not reflect angiographic disease complexity. Their role may lie more in underlying cardiovascular risk assessment than in predicting anatomical severity.

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