Lipoprotein(a) as an Independent Risk Factor and Prognostic Marker of Obstructive Coronary Artery Atherosclerosis in Young Patients: A Literature

Introduction. Lipoprotein(a) (Lp(a)) is a genetically determined, independent risk factor for premature coronary artery atherosclerosis, exhibiting atherogenic, prothrombotic, and pro-inflammatory properties. Aim. To summarize current evidence on the pathophysiology, epidemiology, and clinical significance of Lp(a) in young patients with obstructive coronary artery atherosclerosis, and to review emerging therapeutic strategies for its reduction. Results. Elevated Lp(a) levels (>125 nmol/L) are found in 20-30 % of the general population and up to 40% of young patients with premature coronary artery disease, including those without traditional risk factors. High Lp(a) levels correlate with disease severity (SYNTAX and Gensini scores) and increase the risk of reinfarction and restenosis after percutaneous interventions. Current therapeutic options are limited; the most promising are targeted genetic therapies (pelacarsen, olpasiran, SLN360), which can achieve 80-95 % reductions in Lp(a) levels. Conclusions. Lp(a) measurement should be included in routine screening for high-risk groups. Incorporation of novel therapeutic strategies into clinical practice may significantly improve the prognosis of young patients with premature atherosclerosis.