Mechanisms
Review finds Lp(a) is a weaker predictor of cerebral atherosclerosis and stroke than of coronary disease (Wiad Lek 2025)
Original title: The role of lipoprotein (a) in the development of cerebral atherosclerosis
This narrative review of more than 37 sources examines Lp(a)'s role in intracranial and carotid atherosclerosis, a less well-characterised area than its established role in coronary atherosclerosis. It concludes that plasma Lp(a) measurement by validated assay is sufficient for cardiovascular risk stratification, without need for genetic testing, and that elevated Lp(a) is associated with increased vascular wall inflammation supporting a causal role in atherogenesis. Although intracranial atherosclerosis is a major cause of ischaemic stroke and is linked to recurrent cerebrovascular events and vascular cognitive impairment, the review notes Lp(a)'s predictive value for stroke and cerebral disease is lower than for coronary heart disease, leaving its clinical implications for stroke prevention and vascular dementia in need of further study.
Original abstract
Objective: Aim: To review information sources on this issue in order to provide up-to-date knowledge on the pathogenesis of this condition.
Patients And Methods: Materials and Methods: The PubMed, Embase, and the Cochrane Library databases were searched for studies from inception to April 16, 2022, without language restrictions. Databases were searched for studies from inception 2010 to December, 2024, without language restrictions. Key words for search: Lipoprotein(a), Lp[a], dyslipidemia, classical vascular risk factors, cardiovascular disease, cardiovascular risk, cardiovascular risk factor, cerebral atherosclerosis. More than 37 sources was analyzed.
Conclusion: Conclusions: Cardiovascular diseases remain the leading cause of disability and mortality globally. While dyslipidemia is a well-established risk factor for coronary atherosclerosis and myocardial infarction, its role in the development of intracranial atherosclerosis is less well characterized. Current evidence suggests that plasma measurement of lipoprotein(a) [Lp(a)] using validated assays is sufficient for cardiovascular risk stratification, obviating the need for genetic testing of Lp(a). Advanced diagnostic methods have demonstrated that elevated Lp(a) levels are associated with increased vascular wall inflammation, reinforcing its causal role in atherogenesis. Intracranial atherosclerosis, a major cause of ischemic stroke, is linked to a heightened risk of recurrent cerebrovascular events and the progression of vascular cognitive impairment. Although Lp(a) is a recognized risk factor for stroke, its predictive value appears to be lower than that for coronary heart disease or composite cardiovascular outcomes. Therefore, the clinical implications of elevated Lp(a) levels in relation to carotid and intracranial atherosclerosis merit further investigation, particularly in the context of stroke prevention and vascular dementia.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.