Inflammation
Review by Borén and colleagues explains why Lp(a) is roughly six times more atherogenic than LDL per particle (Curr Opin Cardiol 2024)
Original title: Lipoprotein(a) is a highly atherogenic lipoprotein: pathophysiological basis and clinical implications
This review examines the pathophysiological basis of Lp(a)'s established causal role in atherosclerotic cardiovascular disease and aortic valve stenosis, focusing on ongoing debate over its key pathogenic features relative to LDL. Genetic analyses reviewed here show that, on a per-particle basis, Lp(a) is markedly, roughly six-fold, more atherogenic than LDL, with oxidized phospholipids carried on Lp(a) contributing substantial pro-inflammatory, pro-atherogenic signalling. The authors note ongoing debate over whether Lp(a)'s association with cardiovascular risk depends on inflammatory status, but conclude that most recent large-cohort studies show the Lp(a)-risk relationship is independent of C-reactive protein level. The review frames a better mechanistic understanding of Lp(a)'s enhanced atherogenicity as essential both for risk assessment and for correctly interpreting the results of ongoing Lp(a)-lowering intervention trials.
Original abstract
Purpose Of Review: Lipoprotein(a) has been identified as a causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and aortic valve stenosis. However, as reviewed here, there is ongoing debate as to the key pathogenic features of Lp(a) particles and the degree of Lp(a) atherogenicity relative to low-density lipoprotein (LDL).
Recent Findings: Genetic analyses have revealed that Lp(a) on a per-particle basis is markedly (about six-fold) more atherogenic than LDL. Oxidized phospholipids carried on Lp(a) have been found to have substantial pro-inflammatory properties triggering pathways that may contribute to atherogenesis. Whether the strength of association of Lp(a) with ASCVD risk is dependent on inflammatory status is a matter of current debate and is critical to implementing intervention strategies. Contradictory reports continue to appear, but most recent studies in large cohorts indicate that the relationship of Lp(a) to risk is independent of C-reactive protein level.
Summary: Lp(a) is a highly atherogenic lipoprotein and a viable target for intervention in a significant proportion of the general population. Better understanding the basis of its enhanced atherogenicity is important for risk assessment and interpreting intervention trials.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.