Lp(a) concentration is independently associated with polyvascular disease burden in a retrospective cohort (J Atheroscler Thromb 2026)

Original title: Lipoprotein(a) is Independently Associated with Polyvascular Disease Burden

J Atheroscler Thromb · 7 October 2026 · 7

Yamada R, Kume T, Okamoto H, Matsutani Y, Ichiki K, Murakami Y, Iteya K, Yamada Y, Yamashita M, Koto S, Kamisaka K, Sasahira Y et al.

This retrospective cohort study of 1,799 patients measured Lp(a) concentrations and assessed polyvascular disease burden using a five-domain score. Patients with polyvascular disease had significantly higher Lp(a) levels than those without (57.9 [24.0-118.3] vs. 42.9 [20.2-76.8] nmol/L, P＜0.001). Lp(a) concentrations and the prevalence of elevated Lp(a) (≥ 125 nmol/L) increased progressively with higher polyvascular scores. Multivariable ordinal logistic regression adjusted for age, sex, hypertension, smoking, family history, eGFR, and LDL-C confirmed an independent association between higher Lp(a) and increased polyvascular burden (OR 1.07 per 10 nmol/L increase, 95% CI 1.05-1.10; P＜0.001). The findings quantify Lp(a) as a continuous marker of multi-territory atherosclerosis, though the retrospective design limits causal inference.

Original abstract

Aims: Lipoprotein(a) [Lp(a)] is an established, genetically determined risk factor for atherosclerotic cardiovascular disease. However, its association with the polyvascular disease burden remains unclear. This study investigated the relationship between the Lp(a) concentration and polyvascular disease burden.

Methods: We retrospectively analyzed data from 1,799 patients who underwent Lp(a) measurements between 2012 and 2025. The polyvascular disease burden was assessed using a polyvascular score based on the presence of coronary artery disease, cerebrovascular disease, lower-extremity artery disease, aneurysmal aortic disease, and calcific aortic valve disease. Patients were categorized according to the number of affected disease domains (scores 0, 1, 2, 3, and ≥ 4). A multivariable ordinal logistic regression analysis was performed to identify the factors associated with an increasing polyvascular disease burden.

Results: Patients with polyvascular disease (polyvascular score ≥1) had significantly higher Lp(a) concentrations than those without clinically overt vascular disease (57.9 [24.0-118.3] vs. 42.9 [20.2-76.8] nmol/L, P＜0.001). The Lp(a) concentrations increased progressively with increasing polyvascular scores, and the prevalence of elevated Lp(a) (≥ 125 nmol/L) increased stepwise across the score categories (both P＜0.001). In a multivariable ordinal logistic regression analysis adjusted for age, sex, hypertension, smoking history, family history of ischemic heart disease, eGFR, and LDL-C, higher Lp(a) levels remained independently associated with an increased polyvascular disease burden (OR 1.07 per 10 nmol/L increase, 95% CI 1.05-1.10; P＜0.001).

Conclusions: Higher Lp(a) concentrations were independently associated with an increased polyvascular disease burden, suggesting that Lp(a) may reflect the extent of cardiovascular disease involvement across multiple disease domains.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 11 October 2026. Methods.