Lipoprotein(a) and Coronary Severity: A Cross-Sectional Analysis in Cameroon

Background: Lipoprotein(a) [Lp(a)] is an independent cardiovascular risk factor involved in the occurrence of acute coronary syndromes. However, its relationship with the anatomical severity of coronary lesions remains poorly documented in sub-Saharan Africa. Objective: To assess the association between elevated lipoprotein(a) levels and the severity of coronary lesions in patients admitted for acute coronary syndrome in Yaoundé. Methods: We carried out an observational cross-sectional analytical study using data from the Yaoundé interventional cardiology registry (DéRICA) over a three-year period (November 2022-November 2025). Patients with acute coronary syndrome, significant coronary lesions (≥50%), and elevated lipoprotein(a) levels (≥50 mg/dL) were included. Coronary lesion severity was assessed using the ACC/AHA classification and grouped as non-severe (A, B1) or severe (B2, C). Statistical analyses were performed using logistic regression, with p < 0.05 considered statistically significant. Results: Among patients with elevated lipoprotein(a), a high proportion presented with severe coronary lesions (B2/C). Severe lesions were significantly associated with triple-vessel disease, Heart Team-based therapeutic decision-making, and complex treatment strategies. A near-significant association was observed with left and balanced coronary dominance. Traditional cardiovascular risk factors were not significantly associated with lesion severity. Conclusion: In patients with elevated lipoprotein(a), severe coronary lesions are frequent and reflect a complex anatomical pattern of coronary artery disease. Lipoprotein(a) may serve as a relevant biological marker of coronary lesion severity. Larger multicenter studies are warranted to confirm these findings.