A new study identifies the lipoprotein(a) levels linked to the highest risk.
New findings from more than 20,000 patients in three major NIH studies show that elevated Lipoprotein(a) [Lp(a)] is linked to remaining cardiovascular risk and may call for more aggressive risk reduction.
Lp(a) is a cholesterol-carrying particle in the blood. It resembles LDL, often called “bad” cholesterol, but includes an extra protein that may make it more harmful to the heart and blood vessels. High Lp(a) is mostly inherited and can increase cardiovascular risk even when standard cholesterol levels look normal.
About one in five people has elevated Lp(a), and most do not know it because it typically causes no symptoms. Although high Lp(a) is known to be associated with cardiovascular disease, scientists are still working to understand how well it predicts risk in people with and without existing heart disease.
The late-breaking results were presented at the Society for Cardiovascular Angiography & Interventions (SCAI) 2026 Scientific Sessions and Canadian Association of Interventional Cardiology/Association Canadienne de cardiologie d’intervention (CAIC-ACCI) Summit in Montreal.
Testing a risk threshold
Researchers analyzed stored blood samples from more than 20,000 adults age 40 and older who participated in three major NIH clinical trials. Participants were grouped by their Lipoprotein(a), or Lp(a), levels and whether they already had heart disease. The average participant age was 65, and about 65% were men.
Over nearly four years of follow-up, about 7% of participants experienced a major cardiovascular event such as a stroke, heart attack, artery-opening procedure, or cardiac death.
People with the highest Lp(a) levels were about 30% more likely to experience a major cardiovascular event, nearly 50% more likely to die from cardiovascular disease, and about 65% more likely to have a stroke compared to those with lower levels. The increased risk was especially noticeable in people who already had heart disease, although high Lp(a) was not linked to a greater risk of heart attack.
Blood testing could guide care
“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, FSCAI, interventional cardiologist at Baylor Scott & White in Dallas, Texas.
“Regardless of age, patients can take a simple, low-cost blood test to determine whether they have this genetic condition. 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. This knowledge is especially valuable as new targeted treatment options are on the horizon.”
The researchers said stored biospecimens can reveal new insights from completed clinical trials. They also plan to study additional subgroups, including people with chronic kidney disease and peripheral artery disease.
Reference: “Lipoprotein(a) Identifies Residual Cardiovascular Risk in NIH Randomized Trials” by Subhash Banerjee et al., 24 April 2026, SCAI 2026 Scientific Sessions.
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