Elevated Lp(a) raises stroke recurrence odds by 69% and poor functional outcome odds by over 2-fold, meta-analysis of 17,903 patients finds (J Stroke 2025)

Original title: The Association of Lipoprotein(a) and Stroke Recurrence: A Systematic Review and Meta-Analysis

J Stroke · 1 May 2025 · 7

Palaiodimou L, Melanis K, Stefanou MI, Theodorou A, Giannopoulos S, Lambadiari V, Sousa DA, Sacco S, Katan M, Siasos G, Tsivgoulis G

This systematic review and meta-analysis searched MEDLINE and Scopus for randomised trials and observational studies reporting Lp(a) levels in patients with ischaemic stroke or TIA, to clarify Lp(a)'s role in secondary stroke prevention. Twelve studies (one RCT post-hoc analysis, 11 observational), comprising 17,903 patients (mean age 63, 38% female), were included. Elevated Lp(a) was significantly associated with increased stroke recurrence (OR 1.69, 95% CI 1.09-2.63, P = 0.020) and poor functional outcome (OR 2.09, 95% CI 1.40-3.11, P < 0.001). No significant association was found with all-cause mortality (OR 2.20, 95% CI 0.89-5.43, P = 0.088) or recurrent vascular events (OR 2.66, 95% CI 0.95-7.44, P = 0.063), likely reflecting fewer studies reporting those outcomes. The authors conclude elevated Lp(a) is linked to higher stroke recurrence and worse functional recovery, positioning it as both a promising biomarker and a potential novel therapeutic target for secondary stroke prevention.

Original abstract

Background And Purpose: Lipoprotein(a) [Lp(a)] is a lipoprotein structurally similar to low-density lipoprotein and is considered a genetically determined risk factor for cardiovascular disease. Although Lp(a) has been linked to ischemic stroke, its role in secondary stroke prevention, particularly in stroke recurrence, remains unclear.

Methods: A systematic search of MEDLINE and Scopus databases was conducted to identify randomized controlled trials (RCTs) and observational studies reporting Lp(a) levels in patients with ischemic stroke or transient ischemic attack. The primary outcome was stroke recurrence, and secondary outcomes included poor functional outcome, all-cause mortality, and recurrent vascular events. Pooled odds ratios (ORs) were calculated using a random-effects model.

Results: A total of 12 studies, including one RCT post hoc analysis and 11 observational studies, comprising 17,903 patients (mean age 63 years, 38% female), were included. Elevated Lp(a) levels were significantly associated with increased stroke recurrence (OR: 1.69; 95% confidence interval [CI]: 1.09-2.63; P=0.020) and poor functional outcome (OR: 2.09; 95% CI: 1.40-3.11; P<0.001). No significant associations were found between Lp(a) levels and all-cause mortality (OR: 2.20; 95% CI: 0.89-5.43; P=0.088) or recurrent vascular events (OR: 2.66; 95% CI: 0.95-7.44; P=0.063).

Conclusion: Elevated Lp(a) levels are linked to increased stroke recurrence and poor functional outcome in stroke patients. Lp(a) may represent a novel therapeutic target in secondary stroke prevention in addition to a promising biomarker.

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