UNVEILING THE HIDDEN RISK: LIPOPROTEIN(A) AS A KEY PREDICTOR OF SUBCLINICAL ATHEROSCLEROSIS IN HYPERTENSION

Objective: This study evaluated the relationship between lipoprotein(a) [Lp(a)], hypertension control, and cardiovascular risk in a cohort of hypertensive patients stratified by blood pressure control (<130/80 mmHg vs. less 130/80 mmHg). Associations with subclinical atherosclerosis, cardiovascular events, diabetes, and chronic kidney disease were explored.Design and method: In this multicentre, prospective study of 2,123 patients, Lp(a) levels (>50 mg/dL or >125 nmol/L) and blood pressure control were evaluated. Logistic regression identified independent predictors of subclinical atherosclerosis, and receiver operating characteristic (ROC) analysis determined optimal Lp(a) thresholds. Associations with clinical outcomes were assessed using chi-square and multivariate analyses Results: Elevated Lp(a) was significantly associated with subclinical atherosclerosis (OR = 1.65; 95% CI: 1.40–1.90). Independent predictors included age (OR = 1.10 per year) and gender (female protective, OR = 0.75). Smoking was not significant. The optimal Lp(a) threshold was 20.0 mg/dL (AUC = 0.85) Conclusions: Lp(a) is a strong predictor of subclinical atherosclerosis, particularly in uncontrolled hypertension. These findings underscore its role in cardiovascular risk stratification and highlight the need for further studies to validate these thresholds and evaluate targeted interventions.