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The Association of Lipoprotein(a) and Stroke Recurrence: A Systematic Review and Meta-Analysis

Lina Palaiodimou1, Konstantinos Melanis1, Maria-Ioanna Stefanou1,2,3

  • 1Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.

Journal of Stroke
|June 10, 2025
PubMed

Insights

Elevated Lipoprotein(a) [Lp(a)] levels increase the risk of stroke recurrence and poor functional outcomes in patients who have had an ischemic stroke. Lp(a) shows potential as a biomarker and therapeutic target for secondary stroke prevention.

Area of Science:

  • Cardiovascular Medicine
  • Neurology
  • Clinical Research

Background:

  • Lipoprotein(a) [Lp(a)] is a genetically determined cardiovascular disease risk factor.
  • Lp(a) is structurally similar to low-density lipoprotein.
  • The role of Lp(a) in secondary stroke prevention, specifically stroke recurrence, is not well-defined.

Purpose of the Study:

  • To investigate the association between Lp(a) levels and stroke recurrence.
  • To evaluate Lp(a) as a predictor of functional outcomes post-stroke.
  • To explore Lp(a)'s role in secondary prevention strategies for ischemic stroke.

Main Methods:

  • Systematic search of MEDLINE and Scopus databases for relevant randomized controlled trials (RCTs) and observational studies.
  • Inclusion criteria focused on patients with ischemic stroke or transient ischemic attack reporting Lp(a) levels.
  • Primary outcome was stroke recurrence; secondary outcomes included functional outcome, mortality, and recurrent vascular events. Pooled odds ratios were calculated.

Main Results:

  • Twelve studies (1 RCT analysis, 11 observational) with 17,903 patients were analyzed.
  • Elevated Lp(a) levels significantly correlated with increased stroke recurrence (OR: 1.69) and poor functional outcome (OR: 2.09).
  • No significant associations were found between Lp(a) and all-cause mortality or recurrent vascular events.

Conclusions:

  • Elevated Lp(a) levels are associated with higher rates of stroke recurrence and worse functional outcomes in stroke patients.
  • Lp(a) emerges as a potential novel therapeutic target for secondary stroke prevention.
  • Lp(a) may serve as a valuable biomarker in managing stroke patients.
Abstract

Keywords:
Functional outcomeIschemic strokeLipoprotein(a)Meta-analysisMortalityStroke recurrenceSystematic review

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