First-degree relatives of people with elevated Lp(a) have more MACE: Swedish registry cohort (Kindborg et al., EHJ 2026)

Original title: Major cardiovascular events in first-degree relatives of individuals with elevated plasma lipoprotein(a): a registry-based cohort study

Eur Heart J · 7 July 2026 · 7

Kindborg G, Eriksson Hogling D, Häbel H, Yan J, Hallerbäck T, Lindhe Ö, Hagström E, Andersson DP, Littmann K, Brinck J

From 41,304 index patients with a routine Lp(a) measurement, 61,715 first-degree relatives without a measurement were followed a median 19 years: cumulative MACE incidence to age 65 rose from 6.2 percent for relatives of low-Lp(a) indexes to 8.1 percent for relatives of indexes at or above the 95th percentile (hazard ratio 1.28), and Lp(a) concordance between related indexes was 53 percent above the 80th percentile. Population-scale support for cascade testing.

Original abstract

Background And Aims: Lipoprotein(a) [Lp(a)] levels are genetically determined and causal in the development of atherosclerotic cardiovascular disease. Whether first-degree relatives (FDRs) of individuals with elevated Lp(a) levels (≥80th percentile) have an increased cardiovascular disease risk is unknown.

Methods: Based on 41 304 indexes with a routine plasma Lp(a) measurement, 61 715 FDRs without a measured Lp(a) aged 35-69 years (49% women) were identified in the Swedish STRIREG cohort. First-degree relatives were stratified according to index Lp(a) percentile level: <50th, 50-<80th, 80-<95th, and ≥95th. In competing risk-adjusted cumulative incidence and adjusted Cox proportional hazards regressions, the association between Lp(a) strata and major adverse cardiovascular events (MACE; cardiovascular death, myocardial infarction, ischaemic stroke, coronary revascularization) was investigated. In a nested analysis of 4243 indexes with a first-degree relationship with another index, the concordance of plasma Lp(a) levels was assessed.

Results: During a median follow-up of 19 (11-26) years, 2043 FDRs had a MACE. The cumulative incidences of MACE in FDR until age of 65 were 6.2%, 7.0%, 7.5%, and 8.1% by increasing index Lp(a) level strata (P < .001). Compared with FDR in the lowest Lp(a) stratum, there was a higher hazard ratio for MACE by increasing Lp(a) stratum: 1.08 (95% confidence interval, 0.97-1.19), 1.30 (1.15-1.47), and 1.28 (1.06-1.55; Ptrend < .001). The Lp(a) concordance was 86% (<80th percentile) and 53% (≥80th percentile).

Conclusions: First-degree relatives of individuals with elevated Lp(a) levels have a higher incidence of MACE. Cascade screening could be a feasible strategy to identify FDR at heightened risk.

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