Epidemiology
First real-world Portuguese cohort finds 28.7% have elevated Lp(a), rising to 55.7% among those SCORE2 rates low-to-moderate risk (Lipids Health Dis 2025)
Original title: Prevalence of Lp(a) in a real-world Portuguese cohort: implications for cardiovascular risk assessment
In a retrospective cross-sectional study of 1,134 adults who underwent Lp(a) testing at a Portuguese hospital between August 2018 and June 2022, 28.7% had elevated Lp(a) (above 125 nmol/L), rising to 45.9% among those with established atherosclerotic cardiovascular disease and 41.9% among those with a family history of premature disease. Elevated Lp(a) was significantly associated with hypertension, dyslipidaemia and diabetes. Among patients classified as low-to-moderate risk by the SCORE2 algorithm, 55.7% nonetheless had high Lp(a) (above 75 nmol/L), suggesting SCORE2 alone underestimates their cardiovascular risk. This is the first characterisation of Lp(a) prevalence in a Portuguese population and supports adding Lp(a) to routine risk assessment there.
Original abstract
Background: Cardiovascular disease (CVD) is a major cause of mortality worldwide, necessitating more refined strategies for risk assessment. Recently, lipoprotein(a) [Lp(a)] has gained attention for its distinctive role in atherosclerosis, yet its prevalence and impact for cardiovascular risk assessment are not well-documented in the Portuguese population. This study aimed to characterize Lp(a) levels in a real-world Portuguese cohort, investigating its prevalence and association with CVD risk.
Methods: Retrospective and cross-sectional study of adults who underwent serum Lp(a) analysis in a Portuguese hospital between August 2018 and June 2022. Demographic and anthropometric data, laboratory values, relevant comorbidities and lipid-lowering medication were collected.
Results: Of 1134 participants, 28.7% had elevated Lp(a) levels (> 125 nmol/L). A higher prevalence was observed in those with atherosclerotic cardiovascular disease (ASCVD) (45.9%) or a family history of premature CVD (41.9%). Additionally, a significant association was found between elevated Lp(a) levels and traditional CVD risk factors, including hypertension, dyslipidemia, and diabetes mellitus. Among those classified as having low-to-moderate CVD risk by (Systematic COronary Risk Evaluation 2) SCORE2, 55.7% exhibited high Lp(a) levels (> 75 nmol/L), suggesting a potential higher risk of CVD disease.
Conclusions: The prevalence of elevated Lp(a) in Portugal, notably among those with ASCVD or premature CVD history, is concerning. This study underscores the potential of Lp(a) assessment for a more comprehensive approach to cardiovascular risk assessment. This could improve the stratification of CVD risk and identify individuals who could benefit from early intensive management of their risk factors, ultimately reducing the burden of CVD and cardiovascular-related mortality.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.