Elevated levels of lipoprotein(a) above 175 nmol/L is associated with increased cardiovascular risk, especially among patients with existing heart disease, and warrants aggressive treatment to reduce risk, according to a new study.

“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, MD, an interventional cardiologist at Baylor Scott & White in Dallas.

Banerjee presented the results at the Society for Cardiovascular Angiography and Intervention (SCAI) 2026 in Montreal.

Although the link between high Lp(a) and cardiovascular disease is known, the effect of different levels in the blood and its role in predicting risk among people with and without existing heart disease is not yet understood. So the researchers analyzed plasma samples from more than 20,000 participants, collected as part of three previous NIH trials: ACCORD, PEACE, and SPRINT. Patients were grouped by Lp(a) level (< 75, 75-125, 125-175, or ≥ 175 nmo/L) and whether they had existing heart disease.

After nearly 4 years of follow-up, patients with Lp(a) above 175 nmol/L were 31% more likely to experience a major adverse cardiovascular event. This was driven by elevated risk of both stroke and cardiovascular death, but not heart attack. The effects were more pronounced in those with existing cardiovascular disease, with a hazard ratio of 1.30 vs 1.18 in those without existing disease.

Because Lp(a) levels are largely genetically determined but usually do not cause symptoms, Banerjee recommends all patients get a simple blood test to determine their levels. “If elevated Lp(a) levels are detected, they should work closely with their healthcare provider to aggressively lower LDL cholesterol and manage other cardiovascular risk factors as much as possible,” he said.

J. Dawn Abbott, MD, an interventional cardiologist at Brown University Health Cardiovascular Institute and SCAI president, said measuring Lp(a) can help providers determine which therapies can reduce lifetime risk of cardiovascular disease.

"In the highest quartile, there's an increased risk of major cardiovascular events over the standard known risk factors,” she said. “This can identify patients in whom novel therapies like small, interfering messenger RNAs may work. It's likely that even patients with elevated Lp(a) levels that don't meet that threshold may still benefit from additional therapies."

Banerjee reports research grants from Novartis and GE Healthcare and honoraria from Kaneka and AngioSafe. Abbott reports no relevant financial relationships.

Brian Owens is a freelance journalist based in New Brunswick, Canada.