Aspirin cuts coronary and ASCVD mortality risk by about 50% in people with Lp(a) above 50 mg/dL, review of the evidence for primary prevention finds (Curr Atheroscler Rep 2025)

Purpose Of Review: Elevated Lp(a) is associated with increased risk for atherosclerotic cardiovascular disease (ASCVD), and there is currently a lack of targeted therapies for treating individuals with elevated Lp(a). The purpose of this review is to evaluate the current evidence for aspirin therapy for the primary prevention of ASCVD in individuals with elevated Lp(a).

Recent Findings: Prior studies demonstrated an association between aspirin use and a reduction in cardiovascular events among carriers of particular high-risk LPA single nucleotide polymorphisms. More recent studies have extended these findings by incorporating the more clinically available Lp(a) levels, observing an approximately 50% reduction in risk for coronary heart disease events and ASCVD mortality with aspirin use among individuals with Lp(a) > 50 mg/dL. There is growing evidence for a benefit with aspirin therapy in individuals with elevated Lp(a) without clinical ASCVD. The limitations of the available data must be acknowledged, and shared decision making should be used when discussing with patients, particularly when balancing potential bleeding risk. Future studies are needed to provide more definitive guidance regarding primary prevention aspirin therapy in this population.