Elevated Lp(a) more than doubles arterial stroke risk in children and youth, meta-analysis of 9,923 young patients finds (J Cardiovasc Med (Hagerstown) 2025)

Original title: Lipoprotein(a) in youth and childhood as a marker of cardiovascular risk stratification: a meta-analysis

J Cardiovasc Med (Hagerstown) · 7 April 2025 · 7

Borzillo I, Ascenzo FD, Ravetti E, Balducci M, Pilia R, Michelone M, Annoni G, Toscano A, Giannino G, De Ferrari GM, De Filippo O

This meta-analysis searched PubMed, Scopus and CINAHL Complete from inception to December 2023 for adjusted observational studies examining Lp(a) as a risk factor for premature atherosclerotic disease specifically in children and young patients. Fourteen studies covering 9,923 patients were included; nine assessed Lp(a) as an independent risk factor for premature coronary artery disease (CAD), finding a significant association (OR 1.07, 95% CI 1.01-1.13, P = 0.02). Four studies found high Lp(a) associated with more than double the risk of arterial stroke (OR 2.51, 95% CI 1.51-4.16, P = 0.004). Insufficient studies were available to meta-analyse the secondary endpoints of family history of premature CAD or familial hypercholesterolaemia. The authors conclude Lp(a) is a risk factor for both premature CAD and arterial stroke in the youngest population, supporting its role in early-life cardiovascular risk stratification.

Original abstract

Background And Aims: Lipoprotein(a) [Lp(a)] is recognized as a risk factor for atherosclerotic cardiovascular diseases (ASCVD), yet its impact during childhood and youth remains understudied. This study aims to evaluate the role of Lp(a) as an independent risk factor for premature ASCVD among young patients.

Methods: PubMed, Scopus, and CINAHL Complete databases were systematically searched from inception to 12 December 2023 for adjusted observational studies examining the impact of Lp(a) in young patients. Premature coronary artery disease (CAD) and premature arterial stroke were designed as primary endpoints, while the association with family history of premature CAD and familial hypercholesterolemia were secondary endpoints.

Results: Fourteen studies, encompassing 9923 patients, were included in the analysis. Nine studies assessed Lp(a) as an independent risk factor for premature CAD. Meta-analysis revealed Lp(a) to be significantly associated with premature CAD [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.01-1.13, P = 0.02]. Four studies revealed that the high levels of Lp(a) were associated with a more than two-fold increased risk of arterial stroke (OR 2.51; 95% CI 1.51-4.16, P = 0.004). However, insufficient studies were retrieved to perform a metanalysis for the secondary endpoints.

Conclusion: Findings from adjusted observational studies suggest that Lp(a) serves as a risk factor for premature CAD and for arterial stroke in the youngest population.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.