Epidemiology
Cumulative LDL-C and Lp(a) predict coronary disease in statin-naive elderly, Turkish cohort of 202 (Turk Kardiyol Dern Ars 2026)
Original title: Lipoprotein(a) and Cumulative Low-Density Lipoprotein Cholesterol as Predictors of Coronary Artery Disease in Statin-Naïve Elderly Individuals with Hyperlipidemia
Study of 202 statin-naive patients aged 70 or older (mean age 76, 68.3% female) with LDL-C 160 mg/dL or more and no prior ASCVD or diabetes, undergoing coronary evaluation, testing predictors of coronary artery disease (CAD) including cumulative LDL-C burden and Lp(a). CAD was diagnosed in 30.7% of participants. In multivariable analysis, male sex (OR 2.109), Lp(a) level (OR 1.012 per mg/dL) and cumulative LDL-C (OR 1.155 per g/dL) were independently associated with CAD, with the highest CAD prevalence among those with cumulative LDL-C 14 g/dL or more and Lp(a) 50 mg/dL or more. The SCORE2-OP algorithm failed to predict CAD, while the SAFEHEART risk score was significantly associated with it. The authors conclude male sex, cumulative LDL-C exposure and high Lp(a) independently predict CAD in statin-naive elderly patients, supporting their incorporation into risk stratification for older adults.
Original abstract
Objective: Advanced age is a well-recognized risk factor for atherosclerotic cardiovascular disease (ASCVD). Given the ongoing debate regarding the initiation of statin therapy in elderly individuals, identifying those with underlying coronary artery disease (CAD) who may benefit from lipid-lowering treatment is essential. This study aimed to identify predictors of CAD in statin-naïve adults aged ≥ 70 years with elevated low-density lipoprotein cholesterol (LDL-C), with particular emphasis on risk assessment, cumulative LDL-C burden, and lipoprotein(a) [Lp(a)] levels.
Method: The analysis included consecutive patients aged ≥ 70 years with LDL-C ≥ 160 mg/dL, available Lp(a) measurements, no prior history of ASCVD or diabetes, who underwent evaluation for CAD by coronary imaging or functional stress testing. Global ASCVD risk was estimated using the Systematic Coronary Risk Estimation 2-Older Persons (SCORE2-OP) and the Spanish Familial Hypercholesterolemia Cohort Study (SAFEHEART) risk scores.
Results: A total of 202 patients were included (mean age 76 years; 68.3% female). CAD was diagnosed in 30.7% of participants. In multivariable analysis, male sex (odds ratio [OR]: 2.109), Lp(a) level (OR: 1.012 per mg/dL), and cumulative LDL-C (OR: 1.155 per g/dL) were independently associated with CAD. The highest CAD prevalence was observed among individuals with cumulative LDL-C ≥ 14 g/dL and Lp(a) ≥ 50 mg/dL. While the SCORE2-OP algorithm failed to predict CAD, the SAFEHEART risk score was significantly associated with CAD.
Conclusion: In statin-naïve elderly individuals with elevated LDL-C levels, male sex, cumulative LDL-C exposure, and high Lp(a) levels were independently associated with CAD. These findings underscore the potential utility of incorporating cumulative LDL-C and Lp(a) into risk stratification for older adults.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.