Epidemiology
Lp(a) is firmly linked to large-artery atherosclerotic stroke, but its role in other stroke subtypes stays inconsistent, review of pathways and emerging therapies finds (J Clin Med 2025)
Original title: Lipoprotein(a) as a Stroke Biomarker: Pathophysiological Pathways and Therapeutic Implications
This narrative review examines Lp(a) as a candidate biomarker for cerebrovascular disease, drawing on its genetically determined, lifelong-stable concentration and its pro-atherogenic and pro-thrombotic properties affecting both extracranial and intracranial vessels. Elevated Lp(a) is strongly and consistently associated with large-artery atherosclerotic stroke, while evidence for other ischaemic stroke subtypes and for haemorrhagic stroke remains limited and inconsistent. The authors summarise recent Lp(a)-lowering therapies, including antisense oligonucleotides and RNA-based agents, which have shown significant efficacy in reducing plasma Lp(a), and discuss growing research interest in whether these agents could prevent or treat cerebrovascular disease specifically. The review highlights key evidence gaps, particularly around subtype-specific effects and whether Lp(a) reduction itself translates into lower stroke risk, and calls for future research targeting these open questions.
Original abstract
Lipoprotein(a) [Lp(a)] has attracted widespread interest as a potential biomarker for cerebrovascular diseases due to its genetically determined and stable plasma concentration throughout life. Lp(a) exhibits pro-atherogenic and pro-thrombotic properties that contribute to vascular pathology in both extracranial and intracranial vessels. Elevated Lp(a) levels are strongly associated with large-artery atherosclerotic stroke, while data on its role in other ischemic subtypes and hemorrhagic stroke remains limited and inconsistent. Recent advances in Lp(a)-lowering therapies, such as antisense oligonucleotides and RNA-based agents, have demonstrated significant efficacy in reducing plasma Lp(a) levels. These advances have prompted increasing research into their potential application in the prevention and treatment of cerebrovascular diseases, aiming to determine whether Lp(a) reduction may translate into a reduced risk of stroke and large-artery atherosclerosis. This narrative review summarizes the current evidence on the association between Lp(a) and stroke, focusing on its utility in patient risk stratification. It also highlights existing knowledge gaps and outlines directions for future research, particularly in understanding subtype-specific effects and evaluating the clinical benefits of Lp(a)-targeted therapies.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.