AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Elevated Lipoprotein(a) and Initial Cardiovascular Disease Presentation: Disease-Specific Associations and Age Interactions in a National Cohort
By Chang S, Ramsis M, Naguib M et al.
Introduction/Background: Lipoprotein (a) [Lp(a)] is a genetically determined lipoprotein that is causally associated with multiple cardiovascular diseases (CVD), including myocardial infarction (MI), stroke, peripheral arterial disease (PAD), and aortic stenosis (AS). However, the epidemiology of the first presentation of CVD is not well characterized. Research Questions/Hypothesis: We evaluated the relative strengths of association between elevated Lp(a) (>50 mg/dL) and multiple CVDs with stratification by age, sex, and race/ethnicity. Methods/Approach: We conducted an observational cohort study using Epic Cosmos to identify over 1 million individuals with measured Lp(a). CVD were defined using relevant ICD-10-CM and CPT codes. The association between elevated Lp(a) and CVD was evaluated using a time-to-event analysis using Cox proportional hazards regression adjusted for traditional cardiovascular risk factors. Results/Data: Among individuals with elevated Lp(a), MI was the most common initial event (33.6%, n = 34,309), followed by stroke (31.5%, n = 32,145), PAD (24.2%, n = 24,746), and AS (10.7%, 10,923). Elevated Lp(a) had the strongest association with AS risk (HR 1.60, 95% CI 1.55-1.64), followed by MI (HR 1.44, 95% CI 1.42-1.46), PAD (HR 1.31, 95% CI 1.28-1.33), and stroke (HR 1.15, 95% CI 1.13-1.16). The distribution of CVD events in elevated Lp(a) varied significantly with age (p < 0.001). Stroke predominated in younger patients (age < 30), MI predominated in middle age (age between 30 and 60), and incidence of PAD and AS increased with age ( Figure 1 ). Significant differences in CVD distribution were also observed by sex, race, and ethnicity (all p<0.001). The most frequent initial event was stroke in women (37%), but MI in men (40%). Stroke was the most common event in Black/African American individuals, while MI was most common in other racial groups ( Figure 2 ). Conclusions: To our knowledge, this represents the largest study to date analyzing the association between Lp(a) and initial presentation of CVD across multiple disease types using real-world data. This study helps inform the understanding of the first presentation of CVD among individuals with elevated Lp(a) and differences by baseline demographics.