A hidden cholesterol particle may signal overlooked cardiovascular risk, offering a new clue for prevention and future treatments.
New findings from an analysis of more than 20,000 patients across three major NIH studies show that elevated Lipoprotein(a) [Lp(a)] is linked to ongoing cardiovascular risk, even after standard treatments.
Lp(a) is a cholesterol-carrying particle found in the blood. It resembles LDL, often called “bad” cholesterol, but includes an added protein that may increase its harmful effects on the heart.
High Lp(a) levels are mainly inherited and can raise the risk of cardiovascular disease even when routine cholesterol levels appear normal. About one in five people has elevated Lp(a), though most do not know it because it rarely causes symptoms. While its connection to heart disease is well known, its ability to predict risk in people with and without existing conditions remains unclear.
The results were presented as late-breaking research at the Society for Cardiovascular Angiography & Interventions (SCAI) 2026 Scientific Sessions and the Canadian Association of Interventional Cardiology/Association Canadienne de cardiologie d’intervention (CAIC-ACCI) Summit in Montreal.
Study Design and Methods
The study examined stored plasma samples from 20,070 participants aged 40 and older who were enrolled in the ACCORD, PEACE, and SPRINT NIH randomized trials. Researchers analyzed all samples in a specialized laboratory using a standardized test and reported results in nmol/L.
Participants were categorized by Lp(a) levels (<75, 75 to 125, 125 to 175, or ≥175 nmol/L) and by whether they had preexisting heart disease. Statistical models accounted for factors such as age, health conditions, lipid levels, and treatments.
Key Findings
Participants had an average age of about 65 years, and roughly 65% were men. The main outcome measured was major adverse cardiovascular events (MACE), which included heart attack, stroke, coronary revascularization, or death from heart-related causes.
Over a median follow-up of nearly 4 years, 1,461 events (7.3%) occurred. People with Lp(a) levels of 175 nmol/L or higher had about a 31% higher risk of major cardiovascular events, a 49% higher risk of cardiovascular death, and a 64% higher risk of stroke. This level was not linked to a higher risk of heart attack.
The increased risk was more noticeable in people who already had heart disease, with about a 30% higher risk, compared to an 18% higher risk in those without existing heart disease.
Clinical Implications
“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 added that analyzing stored biological samples can reveal new insights from completed trials. Future work will focus on specific patient groups, including those with chronic kidney disease and peripheral artery disease.
Reference: “Lipoprotein(a) Identifies Residual Cardiovascular Risk in NIH Randomized Trials” by Subhash Banerjee, 24 April 2026, Society for Cardiovascular Angiography & Interventions (SCAI) 2026 Scientific Sessions.
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