Testing
Lp(a) of 149 nmol/L or more flags greater anatomic coronary disease burden, angiography registry of 2230 (Cardiovasc Revasc Med 2026)
Original title: Lipoprotein(a) testing in invasive coronary angiography: Screening yield and anatomic coronary disease burden
Retrospective registry of 2379 consecutive patients undergoing invasive coronary angiography (15 June 2024-1 January 2026), of whom 2230 (1508 men, 722 women) had an Lp(a) measurement. Lp(a) was 125 nmol/L or more in 21.2%, 149 nmol/L or more in 18.5%, 175 nmol/L or more in 14.8%, and 200 nmol/L or more in 11.4% of patients; after conservative renal exclusion, 11.8% remained potential candidates for a major phase 3 Lp(a)-lowering trial framework. Lp(a) 149 nmol/L or more was independently associated with anatomically complex coronary artery disease (SYNTAX score 23 or more, chronic total occlusion, or left main disease; adjusted OR 1.50, 95% CI 1.16-1.94). The authors note elevated Lp(a) was common in this angiography population and identified a higher-burden subgroup, though cross-sectional design cannot establish improved outcomes.
Original abstract
Background: Lipoprotein(a) [Lp(a)] is an inherited lipid-related risk factor that may be overlooked in invasive coronary practice. We assessed the yield of Lp(a) testing in patients undergoing coronary angiography and its association with anatomic coronary disease burden.
Methods: We performed a retrospective registry analysis of consecutive patients undergoing invasive coronary angiography between 15 June 2024 and 1 January 2026. Patients with available Lp(a) measurement were included. We assessed clinically relevant Lp(a) thresholds, reconstructed phase 3 trial-like frameworks for emerging Lp(a)-lowering therapies, and evaluated the association between Lp(a) ≥149 nmol/L and an anatomic complex coronary artery disease endpoint defined as SYNTAX score ≥23, chronic total occlusion, or left main disease. Index revascularization was excluded from this composite.
Results: Among 2379 unique patients, 2230 had available Lp(a) measurement. Men accounted for 1508 (67.6%) and women for 722 (32.4%). The cohort was overwhelmingly White European, although race/ethnicity was not systematically recorded and exact proportions were unavailable. Lp(a) was ≥125, ≥149, ≥175 and ≥200 nmol/L in 473 (21.2%), 413 (18.5%), 330 (14.8%) and 255 (11.4%) patients, respectively. After conservative renal exclusion, 264 patients (11.8%) remained potential candidates for at least one major phase 3 trial-like framework. Lp(a) ≥149 nmol/L was associated with anatomic complex CAD (adjusted odds ratio 1.50, 95% confidence interval 1.16-1.94; p = 0.002).
Conclusions: In this male-predominant registry, Lp(a) elevation was common and identified a subgroup with trial-like screening relevance and greater anatomic CAD burden. Cross-sectional findings do not establish improved management or outcomes; generalizability by sex, age and ancestry requires prospective validation.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.