Lipoprotein(a) [Lp(a)] is increasingly recognized as a contributor to residual cardiovascular risk, although the clinical impact of moderately elevated levels below current guideline thresholds remains uncertain. A study published in the European Journal of Preventive Cardiology analyzed data from 17,376 statin-treated adults aged 45 years or older enrolled in the UK Biobank. Participants had either established atherosclerotic cardiovascular disease (ASCVD) or type 2 diabetes.

The primary endpoint was major adverse cardiovascular events (MACE), defined as nonfatal myocardial infarction, nonfatal stroke, or cardiovascular mortality. Cardiovascular outcomes were compared between the lowest and highest Lp(a) tertiles (<12.5 nmol/L versus >46.8 nmol/L). Dose-response analyses were also performed according to baseline ASCVD status.

Findings

• Compared with the lowest Lp(a) tertile, the highest tertile (>46.8 nmol/L) was associated with a 20% higher risk of MACE (p<0.01).
• Participants in the upper Lp(a) tertile had a 27% higher risk of hospitalization for myocardial infarction (p<0.05).
• Coronary revascularization rates were 34% higher in the upper Lp(a) tertile (p<0.001).
• Cardiovascular mortality was 30% higher among participants with Lp(a) levels >46.8 nmol/L than among those in the lowest tertile (p<0.05).
• Dose-response analyses showed a stronger association between Lp(a) levels and MACE risk in individuals without established ASCVD.

The findings suggest that moderately elevated Lp(a) levels may contribute to residual cardiovascular risk even below current guideline thresholds. The association appeared more pronounced in statin-treated individuals without established ASCVD but with elevated cardiovascular risk.