Whether lipoprotein(a) [Lp(a)] contributes to venous thromboembolism (VTE) may depend on sex and hormonal status. In a UK Biobank analysis published in the European Heart Journal, VTE outcomes were examined across premenopausal women, postmenopausal women, and men using baseline Lp(a) data.

The study included 55,302 premenopausal women, 129,045 postmenopausal women, and 189,013 men after excluding individuals with prior VTE, cancer, or anticoagulant use. Elevated Lp(a), defined as at least 125 nmol/L, was present in 14.0% of premenopausal women, 19.0% of postmenopausal women, and 15.0% of men. Over a median follow-up of 13.6 years (interquartile range, 12.9–14.4), 8,186 VTE events occurred, for a cumulative incidence of 2.2%.

After multivariable adjustment, elevated Lp(a) corresponded with incident VTE in premenopausal women (aHR, 1.32; 95% CI, 1.04-1.66; P=0.02), but not in postmenopausal women overall (aHR, 1.03; 95% CI, 0.94-1.13; P=0.47) or in men (aHR, 1.00; 95% CI, 0.92-1.08; P=0.94). The difference between premenopausal and postmenopausal women was significant (Pinteraction=0.03). 

Oral contraceptive use did not alter the association in premenopausal women (Pinteraction=0.61). Among postmenopausal women using menopausal hormone therapy, elevated Lp(a) was associated with VTE (aHR, 1.48; 95% CI, 1.03–2.12; P=0.03), with significant interaction by MHT use (Pinteraction=0.04).

These findings show that the Lp(a)-VTE relationship was not uniform across groups and was most evident in premenopausal women and postmenopausal MHT users.