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. 2025 Jun 29:23:101055.
doi: 10.1016/j.ajpc.2025.101055. eCollection 2025 Sep.

Demographics of lipoprotein(a) and stroke: The UK biobank

Andrew S Kao  1 , Jonathan Kermanshahchi  2 , Shamim Khosrowjerdi  3 , Alexander C Razavi  4 , Jacqueline Levene  5 , Mikaila Reyes  3 , Parveen Garg  6 , W T Longstreth Jr  7 , Kristiina Rannikmae  8 , Cathie Sudlow  9 , Michael Tsai  10 , Sotirios Tsimikas  11 , Anum Saeed  5 , Harpreet S Bhatia  11
Affiliations

Demographics of lipoprotein(a) and stroke: The UK biobank

Andrew S Kao et al. Am J Prev Cardiol. .

Abstract

Introduction: Lipoprotein(a) [Lp(a)] is associated with ischemic stroke, but the strength of association based on demographic differences remains unclear. We aimed to investigate the association between Lp(a)>125 nmol/L and stroke by age, sex, and racial/ethnic subgroups.

Methods: Using data from the UK Biobank, we included 353,309 participants with an Lp(a) measurement without a history of atherosclerotic cardiovascular disease (ASCVD). Stroke was defined as ischemic stroke or hemorrhagic stroke (with subtypes subarachnoid hemorrhage and intracerebral hemorrhage). Cox proportional hazards models were used to evaluate the association between elevated Lp(a) and stroke (ischemic or hemorrhagic), adjusted for ASCVD risk factors, race/ethnicity, lipid lowering therapy, antiplatelet and anticoagulation medications. Outcomes were defined using ICD-10 codes.

Results: The study population consisted of 55.7 % women and 94 % White individuals with average age of 56 years. The median Lp(a) level was 20.9 [IQR 9.5, 61.4] nmol/L and prevalence of Lp(a) >125 nmol/L was 11.1 % (n = 39,067). Over a median follow-up of 13.8 [13.1, 14.5] years, there were 5002 (1.4 %) ischemic strokes and 1462 (0.4 %) hemorrhagic strokes. Lp(a) > 125 nmol/L was associated with increased risk for ischemic stroke (HR 1.12, 95 % CI 1.02-1.22, P = 0.019), but not hemorrhagic stroke (HR 0.95, 95 % CI 0.79-1.13, P = 0.545). The association between Lp(a)>125 nmol/L and ischemic stroke did not vary by age (p-interaction=0.691) or race/ethnicity (p-interaction 0.526) but did vary by sex (p-interaction=0.041) with an association among men (HR 1.20, 95 % CI 1.07-1.36) but not among women.

Conclusion: Lp(a) is independently associated with ischemic stroke, with variation by sex but not age or race/ethnicity. Lp(a) was not significantly associated with hemorrhagic stroke.

Keywords: Lipoprotein(a); Prevention; Risk factors; Stroke.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Harpreet Bhatia reports a relationship with National Institutes of Health that includes: funding grants. Dr. Alexander C. Razavi reports a relationship with National Heart Lung and Blood Institute that includes: funding grants. Dr. Sotirios Tsimikas reports a relationship with National Heart Lung and Blood Institute that includes: funding grants. Dr. Anum Saeed reports a relationship with American Heart Association Inc that includes: funding grants. Dr. Will Longstreth reports a relationship with National Institutes of Health that includes: funding grants. Dr. Kristiina Rannikmae reports a relationship with UK Biobank that includes: employment. Dr. Cathie Sudlow reports a relationship with UK Biobank that includes: employment. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1
Fig. 1
Association of Lp(a) >125 nmol/L with stroke.
Fig 2
Fig. 2
Association of Lp(a) >125 nmol/L with Ischemic stroke by demographics.
See this image and copyright information in PMC

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