Mechanisms
Lp(a) shifts across pregnancy and menopause and demands sex-specific attention, review of women's cardiovascular health (JACC Adv 2026)
Original title: Lipoprotein(a) and Women's Cardiovascular Health: A Review
Review of lipoprotein(a) in women's cardiovascular health, noting that female sex hormones modulate lipoprotein metabolism and that exogenous and endogenous oestrogen influence Lp(a) levels, producing lifetime fluctuations, particularly during pregnancy and after menopause. Evidence on Lp(a)'s contribution to cardiovascular risk in women remains evolving and sometimes conflicting. Although no approved Lp(a)-lowering drug yet exists, elevated Lp(a) is actionable now through strategies to reduce overall cardiovascular risk. The authors call for clearer communication of Lp(a)-related risk to clinicians managing women's cardiovascular health, and for further research into the interplay of sex, hormones and Lp(a) to inform future cardiovascular prevention.
Original abstract
Elevated lipoprotein(a), or Lp(a), is a genetically determined risk factor for cardiovascular disease (CVD); however, knowledge relating to Lp(a) levels and contribution to CVD risk in women (defined herein as female sex at birth) is evolving and often conflicting. Female sex hormones are important modulators of lipoprotein metabolism, and Lp(a) levels are influenced by exogenous and endogenous estrogen levels. Thus, lifetime fluctuations of Lp(a) are observed, primarily during pregnancy and postmenopause. Although approved pharmacological Lp(a)-lowering therapies are not yet available, elevated Lp(a) is actionable now and strategies can be undertaken to reduce overall CVD risk. It is imperative that knowledge of the risks associated with elevated Lp(a) levels in women is appropriately conveyed to health care professionals to ensure optimal management of CVD risk in real-world practice. Moreover, further research in the field of Lp(a) and women's cardiovascular health is vital for the future of CVD prevention.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.