👤 Terhi Vihervaara

Elevated lipoprotein(a) [Lp(a)] is an important genetic risk factor for cardiovascular diseases (CVDs). Because Lp(a)-lowering therapies are limited, prevention focuses on identifying individuals with elevated Lp(a) and optimizing other modifiable risk factors. We aimed to assess the distribution of Lp(a) levels in Finnish adults and examine its association with other CVD risk factors, as well as the awareness, treatment, and control of dyslipidemia. Data were derived from the Healthy Finland health examination survey conducted in 2023, comprising a nationally representative sample of 5,484 adults. Lp(a) levels were categorized using a cut-point at 125 nmol/L. Other CVD risk factors included were dyslipidemia, abnormal glucose metabolism, hypertension, and obesity. Analyses were weighted taking into account the sampling design and non-participation to provide nationally representative results. Mean Lp(a) levels were 41.7 nmol/L (95% CI 39.0-44.3) in men (M) and 41.9 nmol/L (39.7-44.1) in women (W). Elevated Lp(a) was observed in 11.0% of men and 10.4% of women. Dyslipidemia was more prevalent among individuals with elevated Lp(a) (M: 88.1% vs. 78.4% p = 0.003, W: 79.2% vs. 73.2% p = 0.030) but this association reversed after correcting cholesterol for Lp(a). No associations were found between Lp(a) and other cardiometabolic risk factors. Individuals with elevated Lp(a) had slightly lower unawareness (M: 42.3% vs. 47.5%, p = 0.180, W: 38.8% vs.48.4%, p = 0.042) and better treatment (M: 38.1% vs. 31.7%, p = 0.010, W: 29.2% vs. 24.7%, p = 0.090) of dyslipidemia than those with lower levels while no association was found between Lp(a) and dyslipidemia control (M: 81.4% vs. 84.1%, p = 0.520, W: 74.6% vs. 73.0%, p = 0.740). Approximately one in ten Finnish adults had elevated Lp(a), a lower prevalence than in many other European populations but still affecting a substantial share of the population. Elevated Lp(a) was associated with higher prevalence of dyslipidemia prior to Lp(a) correction, but not with other CVD risk factors, and these individuals also showed slightly greater awareness and treatment of dyslipidemia. These findings emphasize the need for comprehensive management of modifiable CVD risk factors to reduce the overall burden of CVDs. Show less

To quantify international variations in lipid-lowering therapies (LLT) use among patients with coronary heart disease (CHD) and attainment of European guideline-recommended lipid goals. INTERASPIRE is an observational study (2020-23) covering 14 countries from all WHO regions. Patients (18-79 years) hospitalized in the preceding 6-36 months with CHD were invited for standardized interviews and examination, with central laboratory analyses for low-density lipoprotein cholesterol (LDL-C), non-HDL-C, and apolipoprotein B (apoB). Valid lipid data meeting quality control standards were available from 13 countries. Lipid goals followed the 2019 guidelines of the European Atherosclerosis Society and the European Society of Cardiology: LDL-C < 1.4 mmol/L, non-HDL-C < 2.2 mmol/L, and apoB <65 mg/dL.Among 4061 patients (78.8% male, mean age 60.3 years), between index event and interview, 66.3% had no change in treatment intensity. LLT use at interview was largely statin monotherapy: 49.6% high-intensity (inter-country range 5.3%-77.3%) and 24.1% low/moderate-intensity (inter-country range 5.1%-70.1%). Otherwise, 12.2% (inter-country range 0.2%-41.1%) were on combination therapy, and 12.7% on no LLT (inter-country range 3.5%-36.7%). Goal attainment for LDL-C was 17.5%. Corresponding non-HDL-C and apoB goals were achieved by 29.9% and 29.2%, respectively. Higher-income countries (defined by the World Bank's 2024-25 classification of income levels) did better in goal attainment than lower-middle-income countries. In this international study, contemporary lipid goals were not achieved in most CHD patients, with lower-middle-income countries having the worst goal attainment. Contributory factors include absence of any LLT use, low use of combinations and a failure to up-titrate LLT to achieve guideline targets. Show less