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Background <p>High lipoprotein (a) is a risk factor for the development of cardiovascular disease. Lp(a) lowering medications are under investigation in clinical trials. We aimed to assess sex/gender-specific differences in the distribution of Lp(a) levels in patients undergoing coronary artery bypass grafting (CABG).</p> Methods <p>This is a prospective, cross-sectional observational trial including patients undergoing CABG. Patients were classified into Lp(a) categories (Lp(a) (nmol/l) &lt; 62, &gt; 105; ≥ 150; ≥ 175; ≥ 200). Univariate and multivariate analyses were used to test for sex/gender-specific differences in Lp(a) distribution.</p> Results <p>Out of all 413 patients undergoing CABG between 11/2024 and 02/2026, 300 patients signed informed consent and 404 had available Lp(a) values. Women were significantly older (<i>p</i> &lt; 0.001), more often never smokers (<i>p</i> = 0.001) and more frequently had a positive family history (<i>p</i> = 0.001). Median Lp(a) levels did not significantly differ between male and female patients in all 404 patients with available Lp(a) levels (27.8 (IQR 118) versus 37.4 (IQR 206.4); <i>p</i> = 0.165). Female patients were significantly more often distributed in Lp(a) categories &gt; 105 nmol/l, ≥ 150 nmol/l, ≥ 175 nmol/l and ≥ 200 nmol/l, also after adjustment in multivariate analysis.</p> Conclusion <p>A sex/gender-specific difference in Lp(a) distribution was observed. Female patients were more often distributed in higher Lp(a) categories than men, especially in Lp(a) categories &gt; 105, ≥ 150, ≥ 175 and ≥ 200 nmol/l. If Lp(a) lowering agents prove to be effective in clinical trials and currently investigated Lp(a) thresholds are adopted, female patients undergoing CABG may represent a subgroup more likely meeting future treatment eligibility criteria for Lp(a) lowering therapies. The observed difference in Lp(a) distribution may yield a potential contributor to the consistently reported poorer clinical outcomes in women after CABG and warrants further investigation.</p>

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Higher lipoprotein(a) burden in women undergoing coronary artery bypass grafting

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月31日

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  • Hannes Abfalterer,
  • Laura Renz,
  • Christopher Klingler,
  • Lena Gerlach,
  • Valentina Corradini,
  • Nikolaos Bonaros,
  • Michael Grimm,
  • Andrea Griesmacher,
  • Elfriede Ruttmann-Ulmer

摘要

Background

High lipoprotein (a) is a risk factor for the development of cardiovascular disease. Lp(a) lowering medications are under investigation in clinical trials. We aimed to assess sex/gender-specific differences in the distribution of Lp(a) levels in patients undergoing coronary artery bypass grafting (CABG).

Methods

This is a prospective, cross-sectional observational trial including patients undergoing CABG. Patients were classified into Lp(a) categories (Lp(a) (nmol/l) < 62, > 105; ≥ 150; ≥ 175; ≥ 200). Univariate and multivariate analyses were used to test for sex/gender-specific differences in Lp(a) distribution.

Results

Out of all 413 patients undergoing CABG between 11/2024 and 02/2026, 300 patients signed informed consent and 404 had available Lp(a) values. Women were significantly older (p < 0.001), more often never smokers (p = 0.001) and more frequently had a positive family history (p = 0.001). Median Lp(a) levels did not significantly differ between male and female patients in all 404 patients with available Lp(a) levels (27.8 (IQR 118) versus 37.4 (IQR 206.4); p = 0.165). Female patients were significantly more often distributed in Lp(a) categories > 105 nmol/l, ≥ 150 nmol/l, ≥ 175 nmol/l and ≥ 200 nmol/l, also after adjustment in multivariate analysis.

Conclusion

A sex/gender-specific difference in Lp(a) distribution was observed. Female patients were more often distributed in higher Lp(a) categories than men, especially in Lp(a) categories > 105, ≥ 150, ≥ 175 and ≥ 200 nmol/l. If Lp(a) lowering agents prove to be effective in clinical trials and currently investigated Lp(a) thresholds are adopted, female patients undergoing CABG may represent a subgroup more likely meeting future treatment eligibility criteria for Lp(a) lowering therapies. The observed difference in Lp(a) distribution may yield a potential contributor to the consistently reported poorer clinical outcomes in women after CABG and warrants further investigation.