BACKGROUND Serum lipoprotein (a) [Lp(a)] is a causal risk factor for atherosclerotic cardiovascular disease in the general population, but its association with cardiac allograft vasculopathy (CAV) development has not been firmly established. OBJECTIVE To assess the distribution of Lp(a) levels in heart transplant (HT) recipients and evaluate the correlation between Lp(a) levels and the presence and severity of CAV. METHODS A retrospective observational cohort study encompassing 271 adult HT recipients on regular outpatient follow-up in a tertiary center. Lp(a) concentration was assessed during the last follow-up visit and compared between patients with and without clinically significant CAV, International Society for Heart and Lung Transplantation (grade 2-3 vs 0-1). RESULTS Median serum Lp(a) concentration was 40 nmol/L; 62 patients (23%) had Lp(a) >125 nmol/L. Median Lp(a) levels did not significantly differ between patients with CAV 0-1 and patients with CAV 2-3 (median 37 vs 55 nmol/L, P = .408). High (>125 nmol/L) Lp(a) levels were not associated with CAV 2-3, neither on univariable nor on multivariable analysis (hazard ratio multivariate 1.02, 95% CI: 0.35-2.95, P = .977). Elevated Lp(a) concentrations (>75, >125, >200 nmol/L) did not show significant correlation with either CAV 2-3 nor with CAV 1-2-3. Older donor age was significantly related to CAV development (+1.018% increase of CAV for every year of increase of donor age, P value .009). CONCLUSION Elevated serum Lp(a) levels were not associated with the presence and severity of CAV in patients with HT with long post-transplant follow-up. The relationship between Lp(a) and CAV warrants further investigation, given the small sample of the current study.
Association between lipoprotein (a) levels and cardiac allograft vasculopathy among heart transplant recipients: Insights from a single-center cohort
Pradegan N.;Tessari C.;Tarzia V.
2026
Abstract
BACKGROUND Serum lipoprotein (a) [Lp(a)] is a causal risk factor for atherosclerotic cardiovascular disease in the general population, but its association with cardiac allograft vasculopathy (CAV) development has not been firmly established. OBJECTIVE To assess the distribution of Lp(a) levels in heart transplant (HT) recipients and evaluate the correlation between Lp(a) levels and the presence and severity of CAV. METHODS A retrospective observational cohort study encompassing 271 adult HT recipients on regular outpatient follow-up in a tertiary center. Lp(a) concentration was assessed during the last follow-up visit and compared between patients with and without clinically significant CAV, International Society for Heart and Lung Transplantation (grade 2-3 vs 0-1). RESULTS Median serum Lp(a) concentration was 40 nmol/L; 62 patients (23%) had Lp(a) >125 nmol/L. Median Lp(a) levels did not significantly differ between patients with CAV 0-1 and patients with CAV 2-3 (median 37 vs 55 nmol/L, P = .408). High (>125 nmol/L) Lp(a) levels were not associated with CAV 2-3, neither on univariable nor on multivariable analysis (hazard ratio multivariate 1.02, 95% CI: 0.35-2.95, P = .977). Elevated Lp(a) concentrations (>75, >125, >200 nmol/L) did not show significant correlation with either CAV 2-3 nor with CAV 1-2-3. Older donor age was significantly related to CAV development (+1.018% increase of CAV for every year of increase of donor age, P value .009). CONCLUSION Elevated serum Lp(a) levels were not associated with the presence and severity of CAV in patients with HT with long post-transplant follow-up. The relationship between Lp(a) and CAV warrants further investigation, given the small sample of the current study.
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