Lp(a) 50 mg/dL or more raises intracranial stenosis odds 4.5-fold in ischemic stroke, cohort of 397 (J Clin Lipidol 2026)

Original title: High lipoprotein(a) and stroke: Association with large artery and intracranial atherosclerosis-A retrospective study

J Clin Lipidol · 27 January 2026 · 7

Paolucci M, Urbinati G, Gentile M, Forlivesi S, Arnone G, Migliaccio L, Viola MM, Galluzzo S, Fanciulli C, Sebastiani M, Ramazzotti E, Mancini R et al.

Single-center retrospective cohort of 397 patients with ischaemic stroke (from 523 screened, March-December 2021; median age 78, 47% women), testing associations between Lp(a) and large artery atherosclerosis (LAA) subtype and location. Lp(a) was independently associated with LAA (per 10 mg/dL increment, adjusted OR 1.08, 95% CI 1.03-1.14); at a 50 mg/dL threshold, LAA prevalence was 27% versus 15% (adjusted OR 2.71, 95% CI 1.47-5.91). Lp(a) 50 mg/dL or more was strongly associated with intracranial atherosclerotic stenosis (adjusted OR 4.49, 95% CI 2.41-8.38) but not with extracranial carotid stenosis. Statin use (beta 15.01) and LDL-C (beta 0.236) were independently associated with Lp(a) levels. Predicted probability of intracranial stenosis rose steepest with increasing Lp(a). The authors conclude Lp(a) should be included in stroke workup given its strong link to intracranial large-artery disease.

Original abstract

Background: Lipoprotein(a) [Lp(a)] is an independent cardiovascular risk factor, with a growing recognized role in stroke.

Objective: To investigate the association between Lp(a) levels, large artery atherosclerosis (LAA) TOAST (Trial of ORG 10172 in Acute Stroke Treatment) category, and stroke-related atherosclerosis distribution (extracranial/intracranial) in a single-center retrospective cohort of patients with ischemic stroke.

Methods: We included all patients with ischemic stroke admitted between March and December 2021 with Lp(a) levels and computed tomography angiography. Multivariable regression assessed the relationship between Lp(a) and LAA, extracranial carotid stenosis, or intracranial atherosclerotic stenosis (ICAS). Predicted probabilities of atherosclerosis location per Lp(a) increment were estimated from a multinomial logistic regression model.

Results: We screened 523 patients and included 397 with complete data. The median age was 78 years, and 47% were female. Median Lp(a) was significantly higher in patients with stroke-related atherosclerosis, particularly those with intracranial involvement. Statin use (adjusted β = 15.01, 95% CI: 3.32-26.70, P = .012) and low-density lipoprotein levels (adjusted β = 0.236, 95% CI: 0.09-0.38, P = .002) were independently associated with Lp(a). Lp(a) was significantly associated with LAA (per 10 mg/dL increment: adjusted odds ratio [OR]: 1.08, 95% CI: 1.03-1.14, P = .003; for Lp(a) ≥50 mg/dL vs <50 mg/dL, LAA prevalence was 27% vs 15%, P = .007; adjusted OR: 2.71, 95% CI: 1.47-5.91, P = .001). Lp(a) ≥50 mg/dL was significantly associated with ICAS (adjusted OR: 4.49, 95% CI: 2.41-8.38, P < .001), but not with extracranial carotid stenosis (P = .065). With increasing Lp(a) levels, ICAS showed the steepest increase in predicted probability.

Conclusion: Higher Lp(a) values are associated with LAA stroke, particularly ICAS. Lp(a) levels should be included in the stroke workup.

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