Epidemiology
Patients with high Lp(a) but low LDL-C carry over 9 times the ASCVD risk of those with the opposite lipid profile, 8,510-patient study finds (Angiology 2025)
Original title: Elevated Plasma Lipoprotein(a) Level and Atherosclerotic Cardiovascular Disease Risks: A Large Clinical Retrospective Study
This large retrospective study enrolled 8,070 patients with atherosclerotic cardiovascular disease (ASCVD) and 440 without (median age 60, 74.9% male) to examine whether elevated Lp(a) explains ASCVD risk that persists despite well-controlled LDL-C. Multivariate logistic regression identified Lp(a) as a significant independent ASCVD risk factor (OR 1.025, 95% CI 1.020-1.029, P < .001), and when patients were categorised by combined Lp(a)/LDL-C status, those with high Lp(a) but low LDL-C had 9.612 times the odds of ASCVD (95% CI 6.206-14.887, P < .001) compared with the low-Lp(a)/high-LDL-C group. Elevated Lp(a) carried a higher ASCVD risk specifically in men, hypertensive and diabetic patients. This large clinical dataset demonstrates that patients who appear well-controlled by LDL-C alone can still carry substantial, Lp(a)-driven residual cardiovascular risk.
Original abstract
Patients with well-controlled low-density lipoprotein cholesterol (LDL-C) levels still suffer from the progress of the atherosclerotic cardiovascular disease (ASCVD) and can develop adverse outcomes. We conducted this study to analyze the relationship between elevated lipoprotein(a) [Lp(a)] levels and ASCVD risk. We enrolled 8070 patients in the ASCVD group and 440 participants in the non-ASCVD group [median age of 60 years; 6376 (74.9%) were male]. Multivariate logistic regression models were used to identify the relationships between the lipids and ASCVD. These models showed that the Lp(a) level was a significant independent risk factor for ASCVD [odds ratio (OR) = 1.025, confidence interval (CI) = 1.020-1.029, P < .001]. The different categories analysis showed the OR of the high Lp(a)/low LDL-C group was 9.612 [CI = 6.206-14.887], P < .001. Our study demonstrated that elevated Lp(a) levels were associated with the increased ASCVD risk. Also, the patients with low LDL-C but high Lp(a) levels still had a higher risk of developing ASCVD than the low Lp(a)/high LDL-C group. In addition, elevated Lp(a) levels were associated with a higher ASCVD risk in males, hypertensive, and diabetic patients.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.