Combined elevation of Lp(a) and Lp-PLA2 raises 1-year stroke recurrence risk in 10,675 ischaemic stroke and TIA patients (J Clin Lipidol 2024)

Original title: The joint association of lipoprotein(a) and lipoprotein-associated phopholipase A2 with the risk of stroke recurrence

J Clin Lipidol · 1 January 2024 · 7

Xue J, Xiang Y, Jiang X, Jin A, Hao X, Li K, Lin J, Meng X, Li H, Zheng L, Wang Y, Xu J

In a prospective multicentre cohort of 10,675 patients with acute ischaemic stroke or transient ischaemic attack, the combination of elevated Lp(a) (>=50 mg/dL) and lipoprotein-associated phospholipase A2 (Lp-PLA2, >=175.1 ng/mL) was independently associated with stroke recurrence within one year (adjusted HR 1.42, 95% CI 1.15-1.76). Both multiplicative (P=0.004) and additive interaction (relative excess risk due to interaction 0.55, 95% CI 0.20-0.90; attributable proportion 0.39, 95% CI 0.24-0.53) were significant between the two biomarkers. The findings suggest that assessing Lp(a) and Lp-PLA2 jointly, rather than in isolation, better identifies patients at highest risk of stroke recurrence.

Original abstract

Background And Purpose: Currently little is known about the joint association of lipoprotein (a) [Lp(a)] and lipoprotein-associated phospholipase A2 (Lp-PLA2) with stroke recurrence.

Methods: In this prospective multicenter cohort study, 10,675 consecutive acute ischemic stroke (IS) and transient ischemic attack (TIA) patients with Lp(a) and Lp-PLA2 were enrolled. The association of stroke recurrence within 1 year with Lp(a) and Lp-PLA2 was assessed using Cox proportional hazards models and Kaplan-Meier curves. The interaction between Lp(a) and Lp-PLA2 with stroke recurrence was evaluated by multiplicative and additive scales.

Results: A significant joint association of Lp(a) and Lp-PLA2 with the risk of stroke recurrence was observed. Multivariate Cox regression analysis demonstrated that the combination of elevated Lp(a) (≥ 50 mg/dL) and Lp-PLA2 (≥175.1 ng/mL) was independently associated with the risk of stroke recurrence (adjusted hazard ratio: 1.42; 95% confidence interval [CI]: 1.15-1.76). Both significant multiplicative [(exp(β3): 1.63, 95% CI: 1.17-2.29, P = 0.004] and additive interaction (RERI: 0.55, 95% CI: 0.20-0.90, P = 0.002; AP: 0.39, 95% CI, 0.24-0.53) were observed between Lp(a) and Lp-PLA2.

Conclusions: Our results indicated that Lp(a) and Lp-PLA2 have a joint association with the risk of stroke recurrence in IS/TIA patients. Patients with concomitant presence of elevated Lp(a) and Lp-PLA2 have greater risk of stroke recurrence.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.