Lp(a) of 75 nmol/L or more predicts worse neurological outcome after ischemic stroke, Spanish cohort of 300 (Clin Investig Arterioscler 2026)

Introduction: Lipoprotein(a) [Lp(a)] is a modified LDL particle with proatherogenic, proinflammatory, and antifibrinolytic properties, causally associated with vascular disease and ischemic stroke risk. Although evidence exists in Asian populations, few studies have analyzed the relationship between Lp(a) and stroke severity and disability in our population.

Objective: Determine Lp(a) levels in patients with ischemic stroke or transient ischemic attack (TIA) and to explore their association with clinical characteristics, stroke subtypes, and functional outcomes.

Methods: A total of 300 consecutive patients were included, excluding hemorrhagic strokes and alternative diagnoses. Clinical, anthropometric, and biochemical data were collected, including lipid profile and Lp(a), as well as stroke severity (NIHSS) and disability (mRS) scores at admission, discharge, and 90days.

Results: Sixty percent of patients were men, with a mean age of 71years; 20% had a prior ischemic stroke, and nearly half were on lipid-lowering therapy. No significant differences were observed in traditional risk factors, lipid profile, or stroke subtypes according to Lp(a) levels. However, patients with Lp(a) ≥75nmol/l exhibited greater neurological deficit in the acute phase and at discharge, longer hospital stays, and worse functional outcomes according to mRS at discharge and 90days. A positive correlation was identified between Lp(a) and NIHSS/mRS scores.

Conclusions: Elevated Lp(a) levels are associated with greater neurological severity and worse functional recovery after ischemic stroke, suggesting that Lp(a) could serve as an independent prognostic marker, useful for risk stratification and planning intensive rehabilitation strategies.