New NIH Study Links Elevated Lipoprotein(a) to Increased Cardiovascular Risk

New findings from over 20,000 patients in three significant NIH studies indicate that elevated Lipoprotein(a) [Lp(a)] levels may be a contributing factor to cardiovascular risk that persists despite conventional treatments. The results suggest that individuals with high Lp(a) may benefit from more intensive management of other heart disease risk factors. These findings were presented at the 2026 Scientific Sessions of the Society for Cardiovascular Angiography & Interventions (SCAI) and the Canadian Association of Interventional Cardiology/Association Canadienne de cardiologie d’intervention (CAIC-ACCI) Summit in Montreal.

What Is Lipoprotein(a)?

Lp(a) is a cholesterol-carrying particle in the blood that resembles low-density lipoprotein (LDL), often termed “bad” cholesterol. It includes an additional protein that may increase its propensity to contribute to cardiovascular disease. High Lp(a) levels are primarily genetically determined and can elevate cardiovascular risk even when standard cholesterol measurements are within normal limits. Approximately one in five individuals has elevated Lp(a), but many are unaware, as it typically presents no symptoms.

Study Details and Patient Analysis

For this analysis, researchers reviewed plasma samples from 20,070 participants aged 40 and older who were part of the ACCORD, PEACE, and SPRINT NIH randomized trials. The samples were tested in a specialized laboratory, with results measured in nmo/L. Participants were categorized based on their Lp(a) levels (<75, 75-125, 125-175, or ≥ 175 nmo/L) and the presence of pre-existing heart disease. The average age of study participants was 65.2 years, with 64.9% being male. The primary focus was on major adverse cardiovascular events (MACE), including myocardial infarction, stroke, coronary revascularization, or cardiac death.

Findings Linked to High Lp(a) Levels

Over a median follow-up period of 3.98 years, 1,461 MACE events (7.3%) were recorded. An Lp(a) level of 175 nmo/L or greater was independently correlated with an increased risk of MACE (HR 1.31), cardiovascular death (HR 1.49), and stroke (HR 1.64). However, this level was not associated with a greater risk of heart attacks. The association with increased risk was more pronounced in participants with existing heart disease compared to those without.

Importance of Screening

Dr. Subhash Banerjee, an interventional cardiologist at Baylor Scott & White in Dallas, Texas, stated, “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.” He emphasized the accessibility of a simple, low-cost blood test that can help identify individuals with high Lp(a) levels. Those with elevated levels should collaborate with healthcare providers to manage LDL cholesterol and other cardiovascular risk factors effectively.

The researchers also noted the potential to derive new insights from previously stored biospecimens from completed clinical trials. They plan to investigate additional patient populations in future analyses, including those with chronic kidney disease and peripheral artery disease.