Coronary microvascular dysfunction (CMD) constitutes an increasingly acknowledged aspect of coronary artery disease. Even though traditional cardiovascular risk factors have been implicated in CMD pat Show more
Coronary microvascular dysfunction (CMD) constitutes an increasingly acknowledged aspect of coronary artery disease. Even though traditional cardiovascular risk factors have been implicated in CMD pathogenesis, data on lipoprotein (a) [Lp(a)] is limited. This cross-sectional study aimed to investigate whether Lp(a) levels are associated with CMD in patients with angina and nonobstructive coronary arteries. Coronary physiology assessment was performed with the standard bolus thermodilution technique, allowing for coronary flow reserve (CFR) and index of microvascular resistance estimation. Participants were categorized into 3 groups based on Lp(a) levels (<30, [30 to 50], and ≥50 mg/dl) as well as into 2 groups based on the presence of CMD. CMD was defined as CFR ≤2.5 and/or index of microvascular resistance ≥25. A total of 127 patients were recruited. No significant differences in baseline characteristics were observed between the groups. In unadjusted analysis, no significant associations were found. In multivariable analysis adjusting for age and sex, participants with Lp(a) values ≥50 mg/dl displayed a trend for a 4.25 increased CMD risk when compared to participants with Lp(a) values <30 mg/dl (odds ratio 4.25, confidence interval 0.81 to 22.28, p = 0.087). The same group of patients tended to have lower CFR than controls with Lp(a) <30 mg/dl, with a median CFR that was 1.05 units lower (p = 0.086). In conclusion, patients with high Lp(a) levels tended to display a higher prevalence of CMD and lower CFR. More studies are needed in order to better elucidate the relationship between Lp(a) and CMD. Show less
Coronary artery disease (CAD) remains a leading cause of global morbidity and mortality, necessitating continuous refinement in the management of dyslipidemia, one of its major risk factors, to mitiga Show more
Coronary artery disease (CAD) remains a leading cause of global morbidity and mortality, necessitating continuous refinement in the management of dyslipidemia, one of its major risk factors, to mitigate cardiovascular risks. Previous studies have proven the critical role of immediate and robust low-density lipoprotein cholesterol (LDL-C) reduction in the aftermath of acute coronary syndrome (ACS). Emphasizing the evidence supporting this approach, we delve into the impact of early intervention on cardiovascular outcomes and propose optimal strategies for achieving rapid LDL-C lowering, while also providing the rationale for early proprotein convertase subtilisin/kexin 9 inhibitor use after an ACS. Given the importance of the residual lipidemic risk, we present an overview of emerging therapeutic avenues poised to reshape dyslipidemia management, such as bempedoic acid, lipoprotein(a) inhibition, ApoC3 modulation, and angiopoietin-like protein 3 targeting. This comprehensive review amalgamates current evidence with future prospects, offering a holistic perspective on the management of dyslipidemia in CAD. By exploring both the urgency for immediate post-ACS LDL-C reduction and the exciting advancements on the horizon, this article provides a roadmap for clinicians navigating the intricate landscape of lipid-lowering therapies in CAD. Show less