New findings from more than 20,000 patients in three major NIH studies suggest that elevated levels of lipoprotein (a) [Lp(a)] may contribute to cardiovascular risk that persists even after standard treatment. The results indicate that people with high levels of Lp(a) may benefit from more aggressive efforts to reduce other risk factors for heart disease.
The latest findings were presented at the 2026 scientific sessions of the Society for Cardiovascular Angiography and Interventions (SCAI) and at the Canadian Association of Interventional Cardiology/Association Canadienne de Cardiologia de Interventiona (CAIC-ACCI) Summit in Montreal.
What is lipoprotein (a)?
Lp(a) is a cholesterol-carrying particle found in the blood. It is similar to LDL, often called “bad” cholesterol, but includes an additional protein that may make it more likely to contribute to cardiovascular disease.
Elevated Lp(a) levels are largely determined by genetics. They can increase cardiovascular risk even when most familiar cholesterol measurements are within normal ranges. Approximately one in five people has high Lp(a)However, most people with elevated levels don’t know it because the condition typically causes no symptoms.
Scientists have long recognized a connection between elevated Lp(a) and cardiovascular disease. However, researchers are still working to understand how well Lp(a) predicts future risk in people who already have heart disease compared to those who don’t.
More than 20,000 patients analyzed
For the new analysis, researchers examined plasma samples previously collected from 20,070 participants aged 40 and older who had participated in the ACCORD, PEACE, and SPRINT NIH randomized trials.
Samples were analyzed in a dedicated translational laboratory with a standardized assay, and results were reported using the current nmo/L standard. The participants were divided into groups according to their Lp(a) levels (
The researchers then used Cox models that accounted for demographics, comorbidities, lipids, and therapies.
Participants had a mean age of 65.2 ± 8.5 years and 64.9% of patients were men. The researchers focused primarily on major adverse cardiovascular events (MACE), which included myocardial infarction, stroke, coronary revascularization, or cardiac death.
Very high Lp(a) linked to increased risk
During a median follow-up of 3.98 years, 1,461 (7.3%) MACE events occurred.
An Lp(a) level greater than or equal to 175 nmo/L was independently associated with an increased risk of MACE (HR 1.31, 95% CI: 1.10-1.55), cardiovascular death (HR 1.49, 95% CI: 1.07-2.06), and stroke (HR 1.64, 95% CI: 1.14-2.37).
However, having Lp(a) at this level was not associated with an increased risk of heart attack.
The association was also stronger among participants who already had heart disease (HR 1.30, 95% CI: 1.07-1.57) than among those without existing heart disease (HR 1.18, 95% CI: 0.91-1.54).
Simple blood test could reveal hidden risks
“For the first time, we can quantify the specific level of Lp(a) that places patients at significantly increased risk for major cardiovascular events, especially stroke and death,” said Subhash Banerjee, MD, FSCAI, an interventional cardiologist at Baylor Scott & White in Dallas, Texas. “Regardless of age, patients can take a simple, low-cost blood test to determine if they have this genetic condition. If elevated Lp(a) levels are detected, they should work closely with their healthcare provider to aggressively lower LDL cholesterol and control other cardiovascular risk factors as much as possible. This knowledge is especially valuable as new targeted treatment options are on the horizon.”
The researchers also emphasized that stored biological samples can reveal new information from clinical trials that have already been completed. They plan to examine additional patient groups in future analyses, including people with chronic kidney disease and peripheral artery disease.