Very high levels of the inherited cholesterol-related particle Lipoprotein(a) [Lp(a)] were associated with a greater risk of major cardiovascular events, particularly stroke and cardiovascular death, according to findings presented at the Society for Cardiovascular Angiography & Interventions 2026 Scientific Sessions.
Researchers analysed previously collected plasma samples from 20,070 participants aged 40 years and older from three major NIH randomised trials: ACCORD, PEACE, and SPRINT. Participants had a mean age of 65.2 years, and 64.9% were male. Samples were tested using a standardised assay, with participants divided into groups based on Lp(a) levels and the presence of heart disease.
During a median follow-up of approximately four years, 1,461 major adverse cardiovascular events occurred. An Lp(a) level of 175 nmol/L or higher was independently associated with increased risk of major cardiovascular events (HR 1.31), cardiovascular death (HR 1.49), and stroke (HR 1.64). However, elevated Lp(a) was not associated with higher heart attack risk at this threshold.
The association was stronger among participants with existing heart disease than among those without. Approximately one in five people has elevated Lp(a), yet most remain unaware because the condition typically causes no symptoms and is not detected by standard cholesterol testing.
Lp(a) is a cholesterol-carrying particle resembling LDL but with an additional protein that may increase its contribution to cardiovascular disease. Levels are largely determined by genetics and can elevate cardiovascular risk even when standard cholesterol measurements appear normal.
Lead author Dr Subhash Banerjee noted that patients can take a simple, low-cost blood test to detect elevated Lp(a). Those with high levels should work with healthcare providers to aggressively manage other cardiovascular risk factors whilst targeted treatments remain in development.
Source: Science Daily / Society for Cardiovascular Angiography and Interventions (2026)
