Elevated Lp(a) links to multivessel disease and high coronary calcium across two Spanish prevention cohorts of 1,043 (Am J Prev Cardiol 2026)

Original title: Lipoprotein(a) epidemiology and role in secondary and primary-and-a-half cardiovascular prevention: From subclinical atherosclerosis to coronary events

Am J Prev Cardiol · 23 January 2026 · 6

Iwanowski M, Ruiz-Bustillo S, Vime-Jubany J, Zuccarino F, Zerpa DÁP, Jimenez-Mayorga L, Rodriguez S, Rodriguez N, Cabero P, Ivern C, Neus BM, Vaquerizo-Montilla B et al.

Cross-sectional Spanish study of 1043 patients across two cohorts: 788 discharged after non-fatal acute coronary syndrome (secondary prevention) and the remainder asymptomatic with subclinical atherosclerosis ('1.5 prevention'). Median Lp(a) was 61 nmol/L in secondary prevention and 29 nmol/L in the 1.5-prevention cohort; 36.8%, 33.6%, 29.2% and 24.5% of secondary-prevention patients had Lp(a) 125, 150, 175 and 200 nmol/L or more respectively, versus 27.5%, 24.3%, 17.6% and 14.1% in the 1.5-prevention cohort. In secondary prevention, Lp(a) 175 nmol/L or more was independently associated with multivessel disease after adjustment (OR 1.45, 95% CI 1.04-2.01, p=0.027). In the 1.5-prevention cohort, Lp(a) 175 nmol/L or more had an 86% prevalence of coronary artery calcium 300 Agatston units or more, and was associated with it unadjusted (OR 4.47, 95% CI 1.39-20.07, p=0.023), though this lost significance after adjustment. The authors conclude elevated Lp(a) is common in both populations and correlates with greater atherosclerotic burden, supporting systematic Lp(a) assessment.

Original abstract

Introduction: Lipoprotein(a) (Lp[a]) is an independent risk factor for atherosclerotic cardiovascular events and aortic stenosis. In Spain, the prevalence of elevated Lp(a) and its clinical impact remain poorly defined.

Methods: We conducted a cross-sectional study including two cohorts: patients discharged after a non-fatal acute coronary syndrome (secondary prevention), and asymptomatic patients with subclinical atherosclerosis ("1.5 prevention"). The prevalence of elevated Lp(a) levels was assessed in both groups. Associations with multivessel coronary artery disease (secondary prevention) and with a coronary artery calcium (CAC) score ≥300 AU (1.5 prevention) were analyzed.

Results: A total of 1043 patients were included (788 secondary prevention). Median Lp(a) levels were 61 nmol/L in secondary prevention and 29 nmol/L in the 1.5 prevention cohort. In secondary prevention, 36.8%, 33.6%, 29.2%, and 24.5% had Lp(a) ≥125, ≥150, ≥175, and ≥ 200nmol/L, respectively; in the 1.5 prevention cohort the corresponding proportions were 27.5%, 24.3%, 17.6%, and 14.1%. In secondary prevention, Lp(a) ≥175 nmol/L was associated with multivessel disease after multivariable adjustment for age, sex, LDLc, and statin treatment (OR 1.45, 95% CI: 1.04-2.01; p = 0.027). In 1.5 prevention, Lp(a) ≥175 nmol/L showed a prevalence of CAC ≥300 AU of 86%. Elevated Lp(a) (≥175 nmol/L) was associated with CAC ≥300 AU (OR 4.47, 95% CI 1.39-20.07; p = 0.023), although this association lost significance after multivariable adjustment.

Conclusions: Elevated Lp(a) levels are common in both populations and correlate with greater atherosclerotic burden. These findings support the systematic assessment of Lp(a) to guide preventive strategies across both patient populations.

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