Therapy
Aspirin may benefit primary prevention specifically in people with genetically elevated Lp(a), based on subgroup analyses of the Women Health Study and ASPREE (Curr Opin Lipidol 2023)
Original title: Aspirin and lipoprotein(a) in primary prevention
This review examines whether aspirin, which has shown only small benefit in general primary-prevention trials, could still benefit the subset of people with elevated Lp(a), given interactions between Lp(a) and the fibrinolytic and platelet systems and the absence of approved Lp(a)-targeted therapies. Secondary analyses of the Women Health Study and the Aspirin in Reducing Events in the Elderly (ASPREE) trial found that aspirin use was associated with a significant reduction in cardiovascular events specifically among carriers of genetic polymorphisms linked to elevated Lp(a). The author cautions that these findings come from narrower subsets of the original trial populations using genetic markers rather than measured Lp(a) levels, and calls for further study with direct Lp(a) measurement, broader populations, and randomised aspirin allocation before this approach can be recommended.
Original abstract
Purpose Of Review: Lipoprotein(a) [Lp(a)] is causally associated with cardiovascular diseases, and elevated levels are highly prevalent. However, there is a lack of available therapies to address Lp(a)-mediated risk. Though aspirin has progressively fallen out of favor for primary prevention, individuals with high Lp(a) may represent a high-risk group that derives a net benefit.
Recent Findings: Aspirin has been demonstrated to have a clear benefit in secondary prevention of cardiovascular disease, but recent primary prevention trials have at best demonstrated a small benefit. However, individuals with elevated Lp(a) may be of high risk enough to benefit, particularly given interactions between Lp(a) and the fibrinolytic system / platelets, and the lack of available targeted medical therapies. In secondary analyses of the Women's Health Study (WHS) and the Aspirin in Reducing Events in the Elderly (ASPREE) trial, aspirin use was associated with a significant reduction in cardiovascular events in carriers of genetic polymorphisms associated with elevated Lp(a) levels. Further studies are needed, however, as these studies focused on narrower subsets of the overall population and genetic markers.
Summary: Individuals with elevated Lp(a) may benefit from aspirin therapy in primary prevention, but further study with plasma Lp(a) levels, broader populations, and randomization of aspirin are needed.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.