Lipoprotein(a) is a type of cholesterol-carrying particle in the blood. Structurally, it is similar to low-density lipoprotein (LDL), often known as “bad” cholesterol. Typically, treatment options for preventing and managing cardiovascular events may involve lipid-lowering therapies to lower LDL levels.
In addition to having features similar to LDL, Lp(a) also contains proteins that play a role in blood clotting, which may make it even worse than LDL as a risk marker for cardiovascular disease.
Residual cardiovascular risk describes the risk of recurrent vascular events, despite reducing risk factors such as LDL levels. Previous research suggests that Lp(a) levels contribute to cardiovascular risk, independent of LDL levels, and may increase residual risk. However, many people do not typically test Lp(a) levels, despite around 1 in 5 people having elevated levels.
Now, a new analysis suggests that Lp(a) may significantly increase the risk of cardiovascular events, even among people already receiving standard treatments. The results highlight Lp(a) as a potentially important and often overlooked driver of residual cardiovascular risk.
Researchers presented the findings at the Society for Cardiovascular Angiography & Interventions (SCAI) 2026 Scientific Sessions and Canadian Association of Interventional Cardiology/Association Canadienne de cardiologie d’intervention (CAIC-ACCI) Summit in Montreal.
For the study, the researchers analyzed blood samples from 20,070 adults ages 40 years and older who had participated in three large U.S. National Institutes of Health (NIH) trials: the ACCORD, PEACE, and SPRINT.
The average age of participants was roughly 65 years, and about 65% were male. Individuals were grouped based on their Lp(a) levels, ranging from low (less than 75 nanomoles per liter) to very high (equal or more than 175 nmol/L), and whether or not they had existing heart disease.
Over a median follow-up period of nearly 4 years, the team tracked major adverse cardiovascular events (MACE), including heart attack, stroke, and cardiovascular death. Overall, about 7.3% of participants experienced a MACE during the study period.
Notably, they found that individuals with Lp(a) levels of 175 nmol/L or higher had a significantly higher risk of cardiovascular death and stroke. The increased risk was particularly pronounced in those who already had cardiovascular disease.
Cheng-Han Chen, MD, board certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA, who was not involved in the study, told Medical News Today that the identified threshold is very high and could help guide treatment.
“We would generally consider a Lp(a) level of over 125 nmol/L to be high. The threshold of ≥175 nmol/L identified in the study would be considered extremely high and should drive aggressive management of other cardiovascular risk factors.”
— Cheng-Han Chen, MD
Interestingly, the findings suggest that higher Lp(a) levels were not linked to a higher risk of heart attack in this analysis.
Many people receive treatments to lower LDL cholesterol, such as statins. However, even when LDL is well controlled, some individuals may continue to face substantial cardiovascular risk, a phenomenon known as residual risk.
Previous research has suggested that Lp(a) likely plays a role in residual risk. However, despite it affecting 20% of the global population, integrating Lp(a) screening into routine practice has been limited by inconsistent measurement techniques and a lack of targeted treatments.
These findings further highlight the possible role of Lp(a) and identify a clear threshold of 175 nmol/L associated with a higher risk, which could help clinicians better stratify patients and tailor prevention strategies.
Lp(a) levels are primarily determined by genetics, with roughly 70 to 90% of an individual’s Lp(a) level dictated by the LPA gene. Due to this, Lp(a) levels are not significantly influenced by dietary changes, exercise, or lifestyle habits.
However, Lp(a) testing is simple, inexpensive, and can help clinicians to guide treatment.
“We recommend that all adults should have their Lp(a) level tested at least once, in order to help assess their cardiovascular risk,” Chen told MNT.
For those with high Lp(a) levels, a healthcare professional may recommend more aggressive lowering of LDL, strategies to control other risk factors, such as blood pressure and diabetes, and closer cardiovascular monitoring.
“For patients with high Lp(a), we recommend aggressive management of LDL levels, along with lifestyle modifications such as getting regular exercise, eating a heart-healthy diet low in sodium and saturated fat, and avoiding tobacco and alcohol,” Chen explained to MNT.
There are also emerging therapies under development that specifically target Lp(a), raising the possibility of more personalized treatment.
The researchers note that further studies are necessary to explore how Lp(a) affects specific subgroups, including people with chronic kidney disease or peripheral artery disease.
Still, the findings reinforce a growing consensus that measuring Lp(a) could become an important part of routine cardiovascular risk assessment, particularly for those who manage to control LDL levels but remain at risk.
