AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Cardiovascular Risk Associated with High vs Low Lipoprotein(a) Across Black and White Individuals
By Atallah M, Almardini M, Lattouf C et al.
Background: Lipoprotein(a) [Lp(a)] concentrations are higher on average in Black compared with White individuals. While elevated Lp(a) is an established cardiovascular risk factor, whether the cardiovascular risk associated with similarly elevated Lp(a) level differs by race remains incompletely defined. Research Objective: To determine whether the association between elevated lipoprotein(a) and cardiovascular outcomes differs between Black and White individuals. Methods: We performed a retrospective cohort study using a large multi-institutional electronic health record network (TriNetX). Adults with available Lp(a) measurements were categorized as having high (≥100 mg/dL or ≥250 nmol/L) or low (<30 mg/dL or <75 nmol/L) Lp(a) concentrations. Within each racial group (Black, White), cohorts were 1:1 propensity-matched on age, sex, tobacco use, alcohol/substance use, hypertension, diabetes, LDL-C, and total cholesterol. Lp(a) thresholds were selected based on contemporary dyslipidemia guidelines to compare individuals with markedly elevated versus low Lp(a) concentrations. Associations between elevated Lp(a) and cardiovascular outcomes were estimated using odds ratios (ORs) with 95% confidence intervals (CIs). Effect modification by race was assessed using ratios of ORs (Black/White). Results: After matching, 16,745 White and 4,233 Black individuals were included per Lp(a) group. Elevated Lp(a) was associated with higher odds of aortic stenosis, coronary artery disease, myocardial infarction, heart failure, and peripheral artery disease in both Black and White individuals, with similar effect sizes and no evidence of effect modification by race. Elevated Lp(a) was not associated with venous thromboembolism in either group (Figure).In contrast, the association between elevated Lp(a) and ischemic stroke differed by race. Among Black individuals, elevated Lp(a) was associated with increased odds of stroke (OR 1.44, 95% CI 1.25-1.66), whereas no significant association was observed among White individuals (OR 1.08, 95% CI 0.98-1.18). This difference was significant, with a ratio of the ORs of 1.34 (95% CI 1.14-1.58; p=0.0005) (Figure). Conclusions: Elevated Lp(a) is associated with increased risk of multiple cardiovascular outcomes across both Black and White individuals, with similar associations across races. However, a significant association between elevated Lp(a) and ischemic stroke was observed only among Black individuals. These findings suggest that race-related factors may modify the cerebrovascular consequences of elevated Lp(a) and support further investigation into mechanisms linking elevated Lp(a) to ischemic stroke risk in Black populations. Universal Lp(a) screening remains warranted across racial groups, but Black individuals with markedly elevated Lp(a) may represent a subgroup at particularly increased risk for ischemic stroke.