New data analyzing more than 20,000 patients from three major NIH studies show that elevated lipoprotein(a) (Lp(a)) is associated with residual cardiovascular risk and justifies aggressive risk reduction. Researchers presented their latest data today at the Society of Cardiovascular Angiography and Interventions (SCAI) 2026 Scientific Sessions and Canadian Society of Interventional Cardiology/Consortium on Cardiac Interventions (CAIC-ACCI) Summit in Montreal.
Lp(a) is a type of particle in the blood that carries cholesterol. It is similar to LDL, known as “bad” cholesterol, but has additional proteins attached to it that may increase its contribution to heart disease. Elevated Lp(a) levels are primarily genetic and can increase cardiovascular risk even when conventional cholesterol levels are normal. Approximately 1 in 5 people have high Lp(a) levels, which most people don’t realize because it usually doesn’t cause symptoms. Although the association between high Lp(a) and cardiovascular disease is recognized, its role in predicting risk between people with and without heart disease is not yet fully understood.
Researchers analyzed plasma samples from 20,070 participants aged 40 and older previously collected in the ACCORD, PEACE, and SPRINT NIH randomized trials. All samples were evaluated in a dedicated translational laboratory using standardized assays and reported at current standards of nmo/L. Patients were then grouped by Lp(a) level (<75, 75–125, 125–175, or ≥175 nmo/L) and presence or absence of preexisting heart disease. Cox models adjusted for demographics, comorbidities, lipids, and treatments.
The mean age of participants was 65.2 ± 8.5 years, and 64.9% of patients were male. The primary outcome was major major cardiovascular event (MACE) consisting of myocardial infarction, stroke, coronary revascularization, or cardiac death. During a median follow-up of 3.98 years, 1,461 (7.3%) MACE events occurred. Lp(a) ≥175 nmo/L was independently associated with higher risk of MACE (HR 1.31, 95% CI: 1.10-1.55), cardiovascular death (HR 1.49, 95% CI: 1.07-2.06), and stroke (HR 1.64, 95% CI: 1.14-2.37). However, this level of Lp(a) was not associated with an increased risk of heart attack. Additionally, these effects were more pronounced in patients with pre-existing heart disease (HR 1.30, 95% CI: 1.07-1.57) compared to those without heart disease (HR 1.18, 95% CI: 0.91-1.54).
For the first time, we were able to quantify specific Lp(a) levels that significantly put patients at risk for major cardiovascular events, particularly stroke and death. Patients of any age can take a simple, low-cost blood test to determine if they have this genetic disorder. If elevated Lp(a) levels are detected, you should work closely with your healthcare provider to aggressively lower your LDL cholesterol and manage other cardiovascular risk factors to the best of your ability. This knowledge is especially valuable as new targeted treatment options are on the horizon. ”
Subhash Banerjee, MD, FSCAI, Interventional Cardiologist, Baylor Scott & White (Dallas, Texas)
The researchers noted that using biospecimens could provide deeper insight into the completed trials, and they plan to investigate further subgroups such as chronic kidney disease and peripheral artery disease.
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Society of Cardiovascular Angiography and Interventions
