Lp(a) drives adverse cardiac remodeling only in Hispanic adults, MESA cohort of 2,366 (Circ Popul Health Outcomes 2026)

Original title: Association Between Lipoprotein(a) and Cardiac Remodeling Across Race and Ethnicity in the Multi-Ethnic Study of Atherosclerosis

Circ Popul Health Outcomes · 20 February 2026 · 7

Abdollahi A, Ostovaneh A, Chehab O, Hoballah M, Matuck BRS, Wu CO, Whelton SP, Ambale-Venkatesh B, Post WS, Bluemke DA, Tsai MY, Tsimikas S et al.

Multi-Ethnic Study of Atherosclerosis (MESA), a US multicenter cohort (6 sites, enrolled 2000-2002), following 2366 participants with baseline Lp(a) and cardiac MRI at baseline and 10-year follow-up (mean age 60±9, 53% women; 43% White, 24% Black, 21% Hispanic, 12% Chinese), testing Lp(a)'s association with cardiac remodeling across race/ethnicity. In Hispanic participants, each 1-SD increase in log-Lp(a) was associated with increased left ventricular end-systolic volume index (beta 0.60, 95% CI 0.02-1.18), increased left atrial minimum volume index (beta 0.81, 95% CI 0.09-1.52), decreased left ventricular ejection fraction (beta -0.75, 95% CI -1.34 to -0.17), and decreased total left atrial emptying fraction (beta -1.17, 95% CI -2.09 to -0.24), all over a decade. No significant associations were found in White, Black or Chinese participants. The authors conclude Hispanic adults show a unique susceptibility to Lp(a)-mediated adverse cardiac remodeling, independent of ischaemic pathways.

Original abstract

Background: Lp(a) (lipoprotein[a]) is a known cardiovascular risk factor; however, its role in cardiac remodeling and functional changes over time across diverse racial and ethnic groups remains underexplored.

Methods: MESA is a prospective multi-ethnic cohort study of individuals without a history of cardiovascular disease on enrollment (2000-2002), conducted across 6 sites in the United States. Participants with baseline Lp(a) measurements and cardiac magnetic resonance imaging at both baseline and 10-year follow-up exam were included. Lp(a) was treated as both a log-transformed continuous variable (per SD log) and a categorical variable based on data-driven Lp(a) terciles. Multivariable regression models adjusted for sociodemographic, and cardiovascular risk factors, including coronary artery calcium and interim myocardial infarction, were used to assess associations between Lp(a) and longitudinal changes in left ventricular and atrial structure and function over a decade across different racial/ethnic groups.

Results: A total of 2366 participants were included. The average age at baseline was 60±9 with 53% women, 43% White, 24% Black, 21% Hispanic, and 12% Chinese. Each 1-SD increase in log-transformed Lp(a) was associated with an increase in left ventricular end-systolic volume index (β, 0.60 [95% CI, 0.02-1.18]), and left atrial minimum volume index (β, 0.81 [95% CI, 0.09-1.52]), and a decline in left ventricular ejection fraction (β, -0.75 [95% CI, -1.34 to -0.17]), and total left atrial emptying fraction (β, -1.17 [95% CI, -2.09 to -0.24]) in Hispanic subjects over a decade. No significant associations were seen in White, Black, or Chinese participants. The observed findings persisted after adjusting for coronary artery calcium, interim myocardial infarction, and atrioventricular decoupling, and when Lp(a) was treated as a categorical variable with race-specific terciles.

Conclusions: Elevated Lp(a) levels were independently associated with maladaptive left ventricular and left atrial remodeling in Hispanic adults over a decade, while no statistically significant relationships were observed in White, Black, and Chinese participants. This suggests a unique susceptibility of Hispanic individuals to Lp(a)-mediated cardiovascular remodeling, independent of ischemic pathways.

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