Epidemiology
Both very low and very high Lp(a) raise stroke recurrence risk in 3,311 diabetic stroke patients, U-shaped pattern from China's national registry finds (Diabetol Metab Syndr 2025)
Original title: Lp(a) levels and ischemic stroke recurrence in type 2 diabetes mellitus
This study drew on 3,311 patients with type 2 diabetes and recent acute ischaemic stroke or transient ischaemic attack from the Third China National Stroke Registry (2,142 men, 64.69%, median age 63), split into three Lp(a) groups by the 40th and 70th percentiles (13.1 mg/dL, 29.2 mg/dL). Restricted cubic spline analysis revealed a U-shaped relationship between Lp(a) and one-year stroke recurrence: after adjustment, both the lowest group (Lp(a) 13.1 mg/dL or below, HR 1.34, 95% CI 1.02-1.76) and the highest group (29.2 mg/dL or above, HR 1.35, 95% CI 1.01-1.79) had higher total stroke risk than the middle group, with a similar pattern for ischaemic stroke specifically (HR 1.36 for both extremes) but no significant pattern for haemorrhagic stroke. This U-shaped association challenges a simple linear risk model for Lp(a) in diabetic patients recovering from stroke.
Original abstract
Background: We investigated the association between lipoprotein(a) [Lp(a)] levels and stroke recurrence in type 2 diabetes mellitus (T2DM) patients with recent acute ischemic stroke or transient ischemic attack (TIA).
Methods: This study included 3,311 T2DM patients with recent acute ischemic stroke or TIA and complete Lp(a) data from the Third China National Stroke Registry. The patients were categorized into three groups based on the 40th and 70th percentiles of the Lp(a): ≤13.1, 13.1 to 29.2 and ≥ 29.2 mg/dL. The primary outcome was stroke recurrence within one year, with incident cases further classified as either ischemic or hemorrhagic. Cox proportional hazards regression and restricted cubic splines were used to evaluate these associations.
Results: A total of 3311 patients (2142 men, 64.69%, median age 63) were analyzed. Restricted cubic spline analysis revealed a U-shaped relationship between Lp(a) levels and the risk of stroke recurrence. After adjusting for cardiovascular risk factors, patients with Lp(a) levels ≤ 13.1 mg/dL or ≥ 29.2 mg/dL had hazard ratios of 1.34 (95% confidence interval (CI), 1.02-1.76) and 1.35 (95% CI, 1.01-1.79), respectively, for total stroke compared to those with Lp(a) levels between 13.1 and 29.2 mg/dL. The corresponding hazard ratios were 1.36 (95% CI, 1.02-1.81) and 1.36 (95% CI, 1.01-1.83) for ischemic stroke and 0.88 (95% CI, 0.37-2.09) and 0.77 (95% CI, 0.31-1.94) for hemorrhagic stroke, respectively.
Conclusions: Both low and high levels of Lp(a) are associated with an increased risk of stroke recurrence in T2DM patients with a recent history of acute ischemic stroke or TIA, demonstrating a U-shaped relationship.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.