Lower lipoprotein(a) levels in patients with acute lacunar infarction (IBRO Neurosci Rep 2026)

Background: Serum lipoprotein(a) [Lp(a)] is a well-established risk factor for atherosclerotic cardiovascular diseases. However, studies on the correlation between Lp(a) and acute lacunar infarction (ALI) remain inconclusive. We conducted a case-control study to investigate the association between serum Lp(a) levels and ALI in a Chinese population.

Methods: We consecutively enrolled 989 patients with ALI (719 males, 270 females; mean age 64.63 ± 11.97 years) and an equal number of sex-matched controls with available brain MRI from the Departments of Neurology and Geriatrics. Univariate and multivariable binary logistic regression analyses were used to examine the relationships between Lp(a) concentrations and the presence of ALI.

Results: Serum Lp(a) levels were significantly lower in the ALI group compared to controls. Multivariable logistic regression revealed an independent inverse association between Lp(a) levels and the presence of ALI (odds ratio [OR], 0.76; 95% confidence interval [CI], 0.66-0.87; P < 0.001. The trend held across age and sex subgroups (age ≥ 60 years: OR, 0.71; 95% CI, 0.60-0.84; P < 0.001; age < 60 years: OR, 0.76; 95% CI, 0.59-0.98; P = 0.034; males: OR, 0.80; 95% CI, 0.69-0.94; P = 0.007; females: OR, 0.68; 95% CI, 0.53-0.88; P = 0.003). For lesion locations, inverse associations existed in the basal ganglia and brainstem/cerebellum lesions, but not in the subcortical white matter.

Conclusions: This study demonstrates that lower serum Lp(a) levels are independently associated with the presence of ALI. The clinical implications and underlying biological mechanisms of this observation warrant further investigation.