Most people have never heard of lipoprotein(a), but about one in five carry dangerously high levels of it — and standard cholesterol tests won't tell them.
In late-breaking findings presented at the SCAI 2026 Scientific Sessions in Montreal, researchers analyzed plasma samples from 20,070 participants aged 40 and older across three major NIH trials: ACCORD, PEACE and SPRINT. During a median follow-up of just under four years, 1,461 major adverse cardiovascular events occurred.
People with Lp(a) levels of 175 nmol/L or higher faced a 31% higher risk of major cardiovascular events (hazard ratio 1.31), a 49% higher risk of cardiovascular death (HR 1.49), and a 64% higher risk of stroke (HR 1.64) — even after adjusting for demographics, comorbidities, lipids and therapies. Interestingly, no significant association with heart attack was found, and the effect was stronger in people who already had heart disease.
Lp(a) is largely determined by genetics rather than lifestyle, and elevated levels rarely cause symptoms — which is why so many carriers have no idea. "For the first time, we can quantify the specific level of Lp(a) that puts patients at a significantly higher risk of major cardiovascular events, especially stroke and death," said Subhash Banerjee, interventional cardiologist at Baylor Scott & White. "Regardless of age, patients can take a simple, low-cost blood test to determine whether they have this genetic condition."
For people found to have high Lp(a), the findings argue for aggressive management of other cardiovascular risk factors — and the researchers note that new targeted treatment options are on the horizon.
