High Lipoprotein(a) Levels Linked to Increased Cardiovascular Risk, suggests research
Researchers have found in a new study that elevated lipoprotein(a) [Lp(a)] levels (≥175 nmol/L) were identified as strong and independent predictors of major adverse cardiovascular events, including all-cause mortality, cardiovascular death, and stroke over a 7-year period, even after adjusting for traditional risk factors. The associated risk was comparable to that of active smoking. However, no significant association was found between elevated Lp(a) and myocardial infarction. The study was published in the journal Society for Cardiovascular Angiography & Interventions (SCAI 2026).
By taking advantage of this unique situation, the authors studied prospectively acquired samples from 20,070 patients above the age of 40. These samples were analyzed in a specially designed translational lab with standardized assays with measurements performed in units of nmol/L, which is currently the international standard for this measurement. The patient sample had a mean age of 65.2 years (±8.5 years), and the majority (64.9%) were males.
The patients were classified according to their Lp(a) levels, which ranged from less than 75 nmol/L up to 175 nmol/L and beyond, and were also divided according to whether or not they suffered from previous heart disease. With such an exacting research methodology, it became possible for the authors to employ Cox model analysis and isolate the influence of Lp(a) while adjusting for age, comorbidity, and lipid-lowering therapy.
Key findings:
• As shown in the data presented at the SCAI 2026 Scientific Sessions, about one in every five people is genetically susceptible to the condition.
• Within the median follow-up time of 3.98 years, the number of occurrences of MACE reached a total of 1,461, constituting 7.3% of the study sample population.
• From the analysis, it was found that those who have an elevated level of Lp(a) at or above 175 nmol/L had a markedly greater likelihood of meeting the study primary endpoint (HR 1.31; 95% CI: 1.10-1.55).
• Most remarkably, it increased the risk of having a heart-related death by 49% (HR 1.49; 95% CI: 1.07-2.06) and experiencing stroke by 64% (HR 1.64; 95% CI: 1.14-2.37).
• While the risks of stroke and death were very high, no statistically significant connection between this high-risk factor and acute heart attacks was seen in the research.
• Moreover, the hazard ratio of having a cardiovascular event among those who already suffer from heart disease is 1.30 (95% CI: 1.07-1.57), and in comparison, 1.18 for primary prevention.
For these reasons, the researchers found it imperative to measure the exact threshold of 175 nmol/L as an essential guideline for identifying patients at a higher risk of suffering from strokes and heart-related fatalities. By proving that Lp(a), when elevated, is equally associated with additional residual risk as the presence of cigarette smoking, the researchers underscored the significance of testing all patients. These research results become even more important in light of the upcoming development of targeted drugs to reduce Lp(a). In this connection, until such drugs come into use, researchers recommend carrying out Lp(a) testing in order to identify patients who require intensive therapy because of their hereditary susceptibility to the disease.
Reference:
Banerjee, S. (2026). Lipoprotein(a) identifies residual cardiovascular risk in NIH randomized trials. 2026 Scientific Sessions.
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