{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:46:18Z","timestamp":1787507178762,"version":"build-2736575974"},"reference-count":37,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,1,18]],"date-time":"2023-01-18T00:00:00Z","timestamp":1674000000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Lipoprotein(a)-Lp(a), which retains proatherogenic and prothrombotic properties, may be modified by hormonal and metabolic factors. However, few studies have focused on differences related to sex and cardiometabolic risk factors in the relationship between Lp(a) and cardiovascular disease, especially in terms of prognosis. This study aimed at evaluating the predictive value of Lp(a) (cut-off 30 mg\/dL) for hard events (HEs: mortality and non-fatal myocardial infarction) according to sex and cardiometabolic risk factors in 2110 patients (1501 males, mean age: 68 \u00b1 9 years) undergoing coronary angiography for known or suspected coronary artery disease. There were 211 events over a median follow-up period of 33 months. Lp(a) &gt; 30 mg\/dL did not confer a worse prognosis on the overall population. However, Kaplan\u2013Meier subgroup analysis evidenced a worse prognosis in type 2 diabetes (T2D) females with elevated Lp(a) (log-rank test: p = 0.03) vs. T2D males and no-T2D patients, but not in other high-risk cardiovascular states (e.g., smoking, hypertension, reduced left ventricular ejection fraction or obesity). After Cox multivariate adjustment, Lp(a) remained an independent determinant for HEs in the T2D female subgroup, conferring an HR of 2.9 (95% CI 1.1\u20137.7, p &lt; 0.05). Lp(a) is therefore a strong independent predictor of HR in T2D women, but not in T2D men, or in noT2D patients.<\/jats:p>","DOI":"10.3390\/jcm12030764","type":"journal-article","created":{"date-parts":[[2023,1,19]],"date-time":"2023-01-19T05:50:20Z","timestamp":1674107420000},"page":"764","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Lipoprotein(a), Cardiovascular Events and Sex Differences: A Single Cardiological Unit Experience"],"prefix":"10.3390","volume":"12","author":[{"given":"Beatrice","family":"Dal Pino","sequence":"first","affiliation":[{"name":"Fondazione Gabriele Monasterio CNR-Regione Toscana, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4619-6227","authenticated-orcid":false,"given":"Francesca","family":"Gorini","sequence":"additional","affiliation":[{"name":"Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6311-502X","authenticated-orcid":false,"given":"Melania","family":"Gaggini","sequence":"additional","affiliation":[{"name":"Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrizia","family":"Landi","sequence":"additional","affiliation":[{"name":"Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4049-184X","authenticated-orcid":false,"given":"Alessandro","family":"Pingitore","sequence":"additional","affiliation":[{"name":"Institute of Clinical Physiology, National Research Council, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Vassalle","sequence":"additional","affiliation":[{"name":"Fondazione Gabriele Monasterio CNR-Regione Toscana, 56124 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/s11883-021-00940-5","article-title":"Lipoprotein (a): Recent Updates on a Unique Lipoprotein","volume":"23","author":"Saeed","year":"2021","journal-title":"Curr. Atheroscler. Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"13855","DOI":"10.1111\/eci.13855","article-title":"Liver fibrosis scores and prognosis in patients with cardiovascular diseases: A system-atic review and meta-analysis","volume":"52","author":"Yan","year":"2022","journal-title":"Eur J Clin Investig."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1097\/FJC.0000000000001160","article-title":"Lipoprotein(a) and Cardiovascular Disease: A Missing Link for Premature Atherosclerotic Heart Disease and\/or Residual Risk","volume":"79","author":"Melita","year":"2022","journal-title":"J. Cardiovasc. Pharmacol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.atherosclerosis.2022.10.004","article-title":"Relationship of low-density lipoprotein-cholesterol and lipoprotein(a) to cardiovascular risk: The Multi-Ethnic Study of Atherosclerosis (MESA)","volume":"363","author":"Rikhi","year":"2022","journal-title":"Atherosclerosis"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.repc.2019.12.011","article-title":"Lipoprotein(a) in familial hypercholesterolemia: Tips from family history","volume":"40","author":"Sbrana","year":"2021","journal-title":"Rev. Port. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1093\/eurheartj\/ehz455","article-title":"2019 ESC\/EAS Guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society","volume":"1","author":"Mach","year":"2020","journal-title":"Eur. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2844","DOI":"10.1093\/eurheartj\/ehq386","article-title":"Lipoprotein(a) as a cardiovascular risk factor: Current status","volume":"31","author":"Nordestgaard","year":"2010","journal-title":"Eur. Heart J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1312","DOI":"10.2337\/dc19-0274","article-title":"Lipoprotein(a) and cardiovascular outcomes in patients with coronary artery disease and prediabetes or diabetes","volume":"42","author":"Jin","year":"2019","journal-title":"Diabetes Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.amjcard.2021.05.003","article-title":"Effect of Lipoprotein (a) Levels on Long-term Cardiovascular Outcomes in Patients with Myocardial Infarction with Nonobstructive Coronary Arteries","volume":"152","author":"Gao","year":"2021","journal-title":"Am. J. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1186\/s12944-019-1092-6","article-title":"Prognostic value of lipoprotein (a) level in patients with coronary artery disease: A meta-analysis","volume":"18","author":"Wang","year":"2019","journal-title":"Lipids Health Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/0021-9150(95)05600-2","article-title":"Non-enzymatic glycation of lipoprotein(a) in vitro and in vivo","volume":"118","author":"Doucet","year":"1995","journal-title":"Atherosclerosis"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Mahmoodi, M.R., and Najafipour, H. (2022). Association of C-peptide and lipoprotein(a) as two predictors with cardiometabolic biomarkers in patients with type 2 diabetes in KERCADR population-based study. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0268927"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.atherosclerosis.2022.04.006","article-title":"Non-genetic influences on lipoprotein(a) concentrations","volume":"349","author":"Enkhmaa","year":"2022","journal-title":"Atherosclerosis"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1136\/postgradmedj-2019-136591","article-title":"Lipoprotein(a) and coronary artery disease in Chinese postmenopausal female patients: A large cross-sectional cohort study","volume":"95","author":"Liu","year":"2019","journal-title":"Postgrad. Med. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.maturitas.2017.02.009","article-title":"The effect of hormone replacement therapy and tibolone on lipoprotein (a) concentrations in postmenopausal women: A systematic review and meta-analysis","volume":"99","author":"Anagnostis","year":"2017","journal-title":"Maturitas"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/j.jacc.2018.04.060","article-title":"Lipoprotein(a) and Cardiovascular Risk Prediction Among Women","volume":"72","author":"Cook","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2490","DOI":"10.1093\/eurheartj\/ehx166","article-title":"Lipoprotein(a) and the risk of cardiovascular disease in the European population: Results from the BiomarCaRE consortium","volume":"38","author":"Waldeyer","year":"2017","journal-title":"Eur. Heart J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"260","DOI":"10.3109\/13697137.2013.819329","article-title":"Prognostic role of heart rate in patients referred for coronary angiography: Age and sex differences","volume":"17","author":"Vassalle","year":"2014","journal-title":"Climacteric"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.atherosclerosis.2022.04.015","article-title":"Lipoprotein(a) and cardiovascular and valvular diseases: A genetic epidemiological perspective","volume":"349","author":"Arsenault","year":"2022","journal-title":"Atherosclerosis"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1016\/j.jacc.2013.09.042","article-title":"Lipoprotein(a) for risk assessment in patients with established coronary artery disease","volume":"63","author":"Morrow","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/j.jacc.2021.07.016","article-title":"High-Sensitivity C-Reactive Protein Modifies the Cardiovascular Risk of Lipoprotein(a): Multi-Ethnic Study of Atherosclerosis","volume":"78","author":"Zhang","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"154706","DOI":"10.1016\/j.metabol.2021.154706","article-title":"Lipoprotein (a) and coronary artery calcification: Prospective study assessing interactions with other risk factors","volume":"116","author":"Ong","year":"2021","journal-title":"Metabolism"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3389\/fcvm.2022.870341","article-title":"Lipoprotein(a) and Cardiovascular Outcomes in Patients With Coronary Artery Disease and Different Metabolic Phenotypes","volume":"9","author":"Jin","year":"2022","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.atherosclerosis.2022.10.013","article-title":"Lipoprotein(a), high-sensitivity C-reactive protein, and cardiovascular risk in patients undergoing percutaneous coronary intervention","volume":"363","author":"Yuan","year":"2022","journal-title":"Atherosclerosis"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1007\/s11886-019-1182-0","article-title":"Lp(a): Addressing a Target for Cardiovascular Disease Prevention","volume":"21","author":"Vasquez","year":"2019","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1186\/s12944-016-0258-8","article-title":"The relationship between Lp(a) and CVD outcomes: A systematic review","volume":"15","author":"Forbes","year":"2016","journal-title":"Lipids Health Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1194\/jlr.R061648","article-title":"Lipoprotein (a) measurements for clinical application","volume":"57","author":"Marcovina","year":"2016","journal-title":"J. Lipid Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.atherosclerosis.2022.04.016","article-title":"Lipoprotein (a) and diabetes mellitus","volume":"349","author":"Lamina","year":"2022","journal-title":"Atherosclerosis"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1001\/archinte.1996.00440050046005","article-title":"Changes in Lp(a) lipoprotein and lipid levels after cessation of female sex hormone production and estrogen replacement therapy","volume":"156","author":"Kim","year":"1996","journal-title":"Arch. Intern. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.ijcard.2010.02.021","article-title":"Lipoprotein(a) is strongly associated with coronary artery calcification in type-2 diabetic women","volume":"150","author":"Qasim","year":"2011","journal-title":"Int. J. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.jacc.2008.04.009","article-title":"Lipoprotein(a), Hormone Replacement Therapy, and Risk of Future Cardiovascular Events","volume":"52","author":"Danik","year":"2008","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.1093\/eurheartj\/ehi222","article-title":"Lipoprotein (a) and coronary heart disease among women: Beyond a cholesterol carrier?","volume":"26","author":"Shai","year":"2005","journal-title":"Eur. Heart J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1469","DOI":"10.1007\/s00125-005-1814-3","article-title":"A prospective study of lipoprotein(a) and risk of coronary heart disease among women with type 2 diabetes","volume":"48","author":"Shai","year":"2005","journal-title":"Diabetologia"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1016\/j.atherosclerosis.2022.04.020","article-title":"Existing and emerging strategies to lower Lipoprotein(a)","volume":"349","author":"Schwartz","year":"2022","journal-title":"Atherosclerosis"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Gareri, C., Polimeni, A., Giordano, S., Tamm\u00e8, L., Curcio, A., and Indolfi, C. (2022). Antisense Oligonucleotides and Small Interfering RNA for the Treatment of Dyslipidemias. J. Clin. Med., 11.","DOI":"10.3390\/jcm11133884"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"100025","DOI":"10.1016\/j.medntd.2019.100025","article-title":"Gender differences in cardiovascular disease","volume":"4","author":"Gao","year":"2019","journal-title":"Med. Nov. Technol. Devices"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/j.ogc.2011.05.002","article-title":"The Timing of the Age at Which Natural Menopause Occurs","volume":"38","author":"Gold","year":"2011","journal-title":"Obstet. Gynecol. Clin. N. Am."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/3\/764\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:09:03Z","timestamp":1760119743000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/3\/764"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,18]]},"references-count":37,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["jcm12030764"],"URL":"https:\/\/doi.org\/10.3390\/jcm12030764","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,18]]}}}