Lp(a) above 15 mg/dL raises 1-year MACE risk 68% after stroke or TIA, specifically in atherothrombotic subtype, Japanese cohort of 533 finds (Atherosclerosis 2025)

Original title: Residual lipoprotein(a)-associated risk in patients with stroke or transient ischemic attack

Atherosclerosis · 2 May 2025 · 7

Hoshino T, Mizuno T, Arai S, Hosoya M, Wako S, Takahashi S, Oshima R, Higuchi E, Ishizuka K, Toi S, Todo K

This prospective observational study enrolled 533 Japanese patients (mean age 70.7 years, 41.8% women) with ischaemic stroke (n = 496) or high-risk TIA (n = 37) within a week of onset, split by median baseline Lp(a) (15 mg/dL) into low and high groups, and followed for one year. Patients with Lp(a) above 15 mg/dL had more extracranial carotid stenosis (8.8% vs. 15.2%, P = 0.024) and prior coronary artery disease (7.8% vs. 14.1%, P = 0.019), and elevated Lp(a) independently predicted higher risk of major adverse cardiovascular events (MACE): annual rate 10.7% vs. 19.1% (log-rank P = 0.009; adjusted HR 1.68, 95% CI 1.03-2.72, P = 0.037). This association was significant specifically in patients with atherothrombotic stroke (annual rate 14.0% vs. 25.8%, log-rank P = 0.041), but not in those with small vessel disease, cardioembolism, or cryptogenic stroke. The authors conclude Lp(a) above 15 mg/dL refines post-stroke risk assessment, particularly for atherothrombotic stroke, in Japanese patients.

Original abstract

Background And Aims: Lipoprotein (a) [Lp(a)] is a genetically determined risk factor for atherosclerotic cardiovascular diseases. This study aimed to evaluate the association of serum Lp(a) levels with the risk of residual vascular event risk after stroke or transient ischemic attack (TIA) in the Japanese population.

Methods: In this prospective observational study, 533 patients (mean age, 70.7 years; female, 41.8 %) with ischemic stroke (n = 496) or high-risk TIA (n = 37) were consecutively enrolled within 1 week of onset and followed up for 1 year. Patients were divided into 2 groups according to the median baseline Lp(a) levels: (i) low (≤15 mg/dL, n = 270) and (ii) high (>15 mg/dL, n = 263) Lp(a) groups. The primary endpoint was a composite of major adverse cardiovascular events (MACEs), including nonfatal stroke, nonfatal acute coronary syndrome, and vascular death.

Results: Compared to patients with Lp(a) ≤15 mg/dL, those with Lp(a) > 15 mg/dL were more likely to have extracranial carotid artery stenosis (8.8 % versus 15.2 %; p = 0.024) and a history of coronary artery disease (7.8 % versus 14.1 %; p = 0.019). Elevated Lp(a) levels were independently associated with an increased risk of MACE (annual rate, 10.7 % versus 19.1 %; log-rank p = 0.009; adjusted hazard ratio, 1.68; 95 % confidence interval, 1.03-2.72; p = 0.037). When patients were classified according to the etiologic subtype of the index event, elevated Lp(a) was a significant predictor of MACE in patients with atherothrombotic stroke (annual rate, 14.0 % versus 25.8 %; log-rank p = 0.041), but not in those with small vessel disease, cardioembolism, or cryptogenic stroke.

Conclusions: Elevated Lp(a) levels >15 mg/dL in Japanese patients with stroke are associated with extracranial carotid stenosis and a higher risk of MACE. The measurement of Lp(a) levels helped refine the risk assessment of patients with stroke or TIA.

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