Lp(a) is unrelated to body composition, unlike HDL-C and triglycerides, high-risk cohort of 207 (Adv Med Sci 2026)

Purpose: Dyslipidemia remains a major contributor to atherosclerosis and cardiovascular events. While low-density lipoprotein cholesterol (LDL-C) lowering is the primary treatment target, lipoprotein(a) [Lp(a)] has emerged as an independent, genetically determined risk factor, often unaffected by standard treatment. This study aimed to analyze the relationship between body composition parameters and lipid profile, including Lp(a).

Materials And Methods: Clinically stable high cardiovascular risk patients (n = 207) receiving lipid-lowering pharmacotherapy were enrolled in this cross-sectional study. Anthropometric data and body composition were assessed using bioelectrical impedance analysis, including body mass index (BMI), fat mass (FM%) and fat-free mass percentage (FFM%). Lp(a) and lipid profile were measured. Patients were stratified by Lp(a) concentration: <75 nmol/L, 75-125 nmol/L, and >125 nmol/L.

Results: Lp(a) levels showed no significant association with body composition, age, and sex. In contrast, HDL-C was significantly inversely correlated with BMI (R = -0.25, p < 0.001) and this relationship was independent of sex (β = -0.68, p < 0.001), while triglycerides were positively correlated with FM% (R = 0.17, p = 0.02) and BMI (R = 0.28, p < 0.001) and negatively with FFM% (R = -0.17, p = 0.02). LDL-C was not associated with body composition. No significant differences in lipid profile or body composition were observed across Lp(a) strata.

Conclusions: In high cardiovascular risk patients, Lp(a) appears unrelated to body composition, supporting its role as a non-modifiable, genetically driven risk factor. Conversely, despite pharmacotherapy, HDL-C and triglycerides demonstrated significant associations with body fat distribution. These findings suggest clinical role of body composition assessment in cardiovascular risk management, particularly in addressing residual risk beyond LDL-C.