Aspirin for primary prevention in patients with high lipoprotein(a) (Vasc Dis 2026)

Elevated lipoprotein(a) [Lp(a)] is a genetically determined cardiovascular risk factor, linked to both atherosclerotic cardiovascular disease and aortic valve stenosis. Plasma Lp(a) levels between 30-50mg/dL suggest a moderate risk, while levels of 51-180mg/dL indicate high risk, and concentrations exceeding 180mg/dL are linked to a very high cardiovascular risk. Currently, there are no approved therapies specifically indicated to lower Lp(a). Recent evidences indicate a role of aspirin in reducing cardiovascular events in primary prevention in patients with high Lp(a). In this review, we discuss the results of the studies that explored the impact of aspirin in reducing cardiovascular events in primary prevention in patients with increased Lp(a) while waiting for the results from large-scale research initiative exploring the impact of RNA-targeting Lp(a)-lowering therapies in reducing cardiovascular risk. In conclusion, waiting for the ongoing trials on emerging RNA-based therapies, the use of aspirin in a subgroup of patients with high atherosclerotic cardiovascular risk, with very high Lp(a) levels and without important bleeding risk could be an interesting strategy. Emerging RNA-targeted therapies might offer in future increased protection against the occurrence of major atherosclerotic cardiovascular events compared to standard lipid management agents in these patients.