Epidemiology
Lp(a) above 117 nmol/L more than doubles ischaemic stroke risk, driven by the large-artery atherosclerosis subtype, in a case-control study of 231 stroke patients (Neurol Neurochir Pol 2024)
Original title: Lipoprotein (a) concentration as a risk factor for ischaemic stroke and its subtypes
In a prospective case-control study of 231 patients with acute ischaemic stroke and 163 age- and sex-matched controls, serum Lp(a) was significantly higher in cases than controls (81.81 vs 59.75 nmol/L, P=0.036). The highest Lp(a) quartile (>117 nmol/L) carried greater stroke risk than the lowest (<13 nmol/L; OR 2.23, 95% CI 1.23-4.03, P=0.008), an association that remained significant after adjustment for established risk factors (OR 1.99, 95% CI 1.05-3.76, P=0.04). Lp(a) >75 nmol/L (30 mg/dL) was specifically associated with the large-artery atherosclerosis stroke subtype (adjusted OR 2.54, 95% CI 1.39-4.67, P=0.003), with no significant association for other subtypes. The findings identify Lp(a) as an independent risk factor for ischaemic stroke, particularly its large-artery atherosclerotic subtype.
Original abstract
Aim Of The Study: To investigate the relationship between serum lipoprotein (a) [Lp(a)] concentration and the risk of ischaemic stroke (IS) and its subtypes.
Clinical Rationale For The Study: Lp(a) plays a role in atherogenic, pro-thrombotic, and antifibrinolytic processes. Elevated plasma Lp(a) is a strong independent risk factor for the development and progression of atherosclerotic disease. The association between lipoproteins and IS is more complex than that reported for cardiovascular diseases, with inconsistent and contradictory results from epidemiological studies.
Material And Methods: 231 patients with acute IS (defined as cases) and 163 age- and sex-matched control subjects were included in this prospective case-control study. Demographic and clinical variables (i.e. age, sex, smoking, presence of chronic diseases and concomitant medication) and laboratory data (i.e. concentrations of total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, triglycerides, Lp(a), apolipoprotein A1, apolipoprotein B) were recorded.
Results: The mean age and the percentage of men did not significantly differ between groups. Compared to controls, there was a significantly higher percentage of cases reported with concomitant diseases: diabetes mellitus, myocardial infarction, ischaemic heart disease, peripheral arterial disease, and atrial fibrillation. The study showed a significantly higher serum Lp(a) concentration in cases than in control subjects (81.81 nmol/L [c.32.7 mg/dL] vs. 59.75 nmol/L [c.23.9 mg/dL]; p = 0.036) and found an association between Lp(a) levels stratified by quartiles and the risk for ischaemic stroke (Q1 [Lp(a) < 13 nmol/L] vs. Q4 [Lp(a) > 117 nmol/L]: OR 2.23; 95% CI 1.23-4.03; p = 0.008). A subgroup analysis based on the TOAST classification of IS also showed a significant association between Lp(a) value of more than 75 nmol/L (30 mg/dL) and the risk of large-artery atherosclerosis stroke compared to the controls (OR 2.4; 95% CI 1.39-3.93; p = 0.001), as well as a statistically non-significant association with other subtypes of IS. The influence of Lp(a) remained significant even after adjusting for established risk factors for IS (OR 1.99; 95% CI 1.05-3.76; p = 0.04; respectively for the large-artery atherosclerotic subtype: OR 2.54; 95% CI 1.39-4.67; p = 0.003).
Conclusion: We found that Lp(a) is an independent risk factor for ischaemic stroke, and for the large-artery atherosclerotic subtype of ischaemic stroke.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.