Very high Lp(a) predicts earlier heart attack and 16-fold higher recurrent MI risk, matched cohort of 446 (JACC Adv 2026)

Original title: Lipoprotein(a) and the Early Diagnosis, Complexity, and Extent of Coronary Artery Disease and Myocardial Infarction

JACC Adv · 19 January 2026 · 8

Coerkamp CF, Verpalen VA, Bouhbouh K, Renkens MPL, Witte LS, Kaiser Y, Kuipers RS, Chamuleau SAJ, Knaapen P, Delewi R, Claessen BEPM, Grundeken MJ et al.

Cohort of 446 individuals with very high Lp(a) (above 230 nmol/L) matched 2:1 by age and sex to 223 controls with low Lp(a) (7 nmol/L or below), median follow-up age 60 years (Q1-Q3 50-71), testing associations with obstructive coronary artery disease (CAD) diagnosis, complexity and myocardial infarction (MI). Very high Lp(a) was associated with significantly shorter CAD- and MI-free survival (p=0.006 and p=0.012) and with multivessel CAD (adjusted OR per 100 nmol/L 1.43, 95% CI 1.04-1.96), but not with intermediate/high SYNTAX score (adjusted OR 1.28, 95% CI 0.82-1.99). Very high Lp(a) carried a 2.4-fold higher risk of ST-elevation MI and a 15.9-fold higher risk of recurrent MI than low Lp(a). The authors conclude very high Lp(a) is associated with earlier diagnosis of obstructive CAD and MI, particularly STEMI, with a striking excess risk of MI recurrence.

Original abstract

Background: Lipoprotein(a) [Lp(a)] is a potent, independent causal risk factor for coronary artery disease (CAD).

Objectives: This study aimed to assess the association between Lp(a) and the diagnosis, clinical presentation, and angiographic characteristics of obstructive CAD and occurrence of myocardial infarction (MI).

Methods: We included 446 individuals with very high Lp(a) (>230 nmol/L) who underwent routine lipid profiling, matched 2:1 by age and sex using nearest-neighbor propensity matching to 223 controls with low Lp(a) (≤7 nmol/L). Kaplan-Meier analysis was used to assess CAD- and MI-free survival. Multivariable ORs were calculated for multivessel disease and the SYNergy Between percutaneous coronary intervention with TAXus and Cardiac Surgery-1 score.

Results: Median follow-up time, defined by age at last follow-up, was 60 years (Q1-Q3: 50-71). Individuals with very high Lp(a) had significantly lower event-free survival time for the diagnosis of obstructive CAD and occurrence of MI (P = 0.006 and P = 0.012, respectively). In multivariable analysis, Lp(a) was associated with multivessel CAD (adjusted OR: 1.43 [per 100 nmol/L]; 95% CI: 1.04-1.96; P = 0.028), but not with an intermediate or high SYNergy Between percutaneous coronary intervention with TAXus and Cardiac Surgery-1 score (adjusted OR: 1.28 [per 100 nmol/L]; 95% CI: 0.82-1.99, P = 0.279). Individuals with very high Lp(a) levels had a 2.4-fold higher risk of ST-segment elevation MI and a 15.9-fold higher risk of recurrent MI compared to those with low Lp(a).

Conclusions: Very high Lp(a) is associated with earlier diagnosis of obstructive CAD and MI, predominantly ST-segment elevation MI. In addition, individuals with very high Lp(a) levels seem at a particular high risk of recurrent MI.

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