Lipoproteïne(a) in risicoschatting verhoogt statine-indicatie bij laagrisicopatiënten — 2026 ACC/AHA-richtlijn

BACKGROUND: Though elevated lipoprotein (a) (Lp[a]) is associated with ASCVD and testing is recommended for all adults, how to use Lp(a) for decision-making in low-risk patients remains uncertain. METHODS: We studied low-risk adults in a large healthcare system, excluding those on statins or with statin indications in the 2026 ACC/AHA dyslipidemia guideline. ASCVD risk and statin eligibility were estimated using the PREVENT equations, incorporating Lp(a) using a calculation proposed by the AHA: ASCVD risk x (1.11^[(Lp[a] in nmol/L)/50]). Measured Lp(a) was used when available, and imputed values were used for all other adults. RESULTS: The cohort included 124 low-risk patients with measured Lp(a) (median [25th-75th percentile] age 44 [38-50] years; 64.5% women) and 28,527 without Lp(a) (median age 42 [36-49] years, 73.3% women). Adding Lp(a) to 10-year risk equations made 3.3% of patients with measured Lp(a) ≥125 nmol/L and 0.1% with imputed Lp(a) of 125 nmol/L newly statin eligible. Eligibility rose with older age, higher Lp(a), and higher ASCVD risk. When Lp(a) was added to 30-year risk in exploratory analyses, 20.2% with measured Lp(a) and 19.6% with imputed Lp(a) of 125 nmol/L met statin eligibility, and 70.0-84.6% (measured cohort) and 33.1-54.2% (imputed cohort) at the highest Lp(a) quintile met eligibility as age increased. CONCLUSIONS: Integrating Lp(a) into ASCVD risk equations changes predicted risk and potential statin eligibility in low-risk adults not indicated for therapy under current guidelines. Including Lp(a) in risk estimation and clinical decision-making, particularly for patients with elevated levels, could be considered in patients with low ASCVD risk.