Epidemiology
Elevated Lp(a) raises cardiovascular event odds (OR 5.3) in people living with HIV, 186-patient cohort (Clin Med Lond 2026)
Original title: Prevalence and cardiovascular associations of elevated lipoprotein(a) in people living with HIV: A cross-sectional study
Single-centre cross-sectional study of 186 adults living with HIV and sustained virological suppression, assessing the prevalence and cardiovascular associations of elevated lipoprotein(a) (Lp(a) above 50 mg/dL). Elevated Lp(a) was present in 21% of participants and was associated with higher total cholesterol, LDL-C and apolipoprotein B, and with higher odds of a cardiovascular event (OR 5.3, p=0.018). Despite more frequent use of lipid-lowering therapy, patients with elevated Lp(a) less often reached their LDL-C target than those with Lp(a) below 50 mg/dL. No association was found between elevated Lp(a) and antiretroviral regimen, CD4 count, CD4/CD8 ratio, or duration of HIV infection, suggesting Lp(a) adds an HIV-independent layer of residual cardiovascular risk.
Original abstract
Background: Lipoprotein(a) [Lp(a)] has emerged as an important cardiovascular risk factor. However, the prevalence and determinants of elevated Lp(a) in people living with HIV (PLHIV) remain insufficiently characterised. Since PLHIV have an increased cardiovascular risk even under effective virological control, our aim was to explore the prevalence of elevated Lp(a) and its association with cardiovascular risk in this population.
Methods: We conducted a single-centre observational study in adult PLHIV with sustained virological suppression and without active oncological or infectious comorbidities. According to most international consensus statements, elevated Lp(a) was defined as levels >50 mg/dL.
Results: A total of 186 PLHIV were included. Of these, 21% had Lp(a) levels >50 mg/dL. Individuals with elevated Lp(a) had significantly higher total cholesterol, Low-density lipoprotein cholesterol (LDL-C) and apolipoprotein B levels, as well as a higher odds of a cardiovascular event [odds ratio (OR) 5.3, p = 0.018]. Although the proportion of patients receiving lipid-lowering therapy was significantly higher among those with elevated Lp(a), the percentage achieving LDL-C targets according to cardiovascular risk was significantly lower compared with patients with Lp(a) <50 mg/dL. No association was observed between elevated Lp(a) and antiretroviral therapy regimens, CD4 count, CD4/CD8 ratio or duration of HIV infection.
Conclusions: In our study, elevated Lp(a) was present among 21% of virologically suppressed PLHIV and was associated with an adverse lipid profile and cardiovascular events, whereas no association was observed with HIV-related factors. Lp(a) may represent a marker of residual cardiovascular risk in this population and could help refine cardiovascular risk stratification beyond traditional lipid parameters.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.