Epidemiology
Elevated Lp(a) independently raises new-onset atrial fibrillation risk by 11%, 75,376-patient Mayo Clinic cohort finds (Eur J Prev Cardiol 2025)
Original title: Elevated lipoprotein(a) levels linked to new-onset atrial fibrillation: insights from a retrospective cohort study
This retrospective multicenter study drew on adult patients from three Mayo Clinic sites with a baseline Lp(a) measurement and no prior atrial fibrillation (AF), comparing those with high (50 mg/dL or above) versus low Lp(a) for incident AF risk over up to 15 years. Among 75,376 patients (median age 55, 59% male, median follow-up 8.8 years), 5,738 (7.6%) developed incident AF. Survival free from AF was significantly lower with elevated Lp(a) (86% vs. 88%, log-rank P < 0.001), and multivariable Cox regression adjusted for AF risk factors confirmed elevated Lp(a) independently raised AF risk by 11% (adjusted HR 1.11, 95% CI 1.05-1.18). The authors conclude Lp(a) of 50 mg/dL or above is an independent AF risk factor, distinct from its established atherosclerotic role, and call for prospective studies to test whether Lp(a)-lowering could reduce AF burden.
Original abstract
Aims: Atrial fibrillation (AF) is the most common cardiac arrhythmia. Although lipoprotein(a) [Lp(a)] is known to be a well-established risk factor for atherosclerotic cardiovascular disease, its role in the development of AF, independent of this association, remains unclear.
Methods And Results: Adult patients from the three Mayo Clinic sites with a baseline Lp(a) and without AF history were included. Patients were categorized into two groups based on their Lp(a) levels: high Lp(a) (≥50 mg/dL) and low Lp(a) (<50 mg/dL). Survival probabilities free from incident AF were compared between Lp(a) groups, during a follow-up period up to 15 years, using the Kaplan-Meier curve and the log-rank test. Multivariable Cox regression analysis was also conducted. A total of 75 376 patients were included (median age: 55 years, 59% males), with a median follow-up duration of 8.8 (inter-quartile range: 3.4, 14.8) years. Incident AF was detected in 5738 (7.6%) patients. Survival probability free from incident AF was significantly lower in patients with elevated Lp(a) (86%) compared with those with low Lp(a) (88%, log-rank P < 0.001). Multivariable analysis adjusted for potential risk factors of AF showed a statistically significant association of elevated Lp(a) with an 11% increase in AF risk (adjusted hazard ratio: 1.11, 95% confidence interval: 1.05-1.18).
Conclusion: Our study suggests that elevated Lp(a) (≥50 mg/dL) is an independent risk factor for incident AF. Future prospective studies are warranted to validate our results and to test if reducing Lp(a) could mitigate the burden of AF.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.