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Lipoprotein(a) and aortic diseases: Epidemiological evidence from observation to causation

Dexiang Xia1, Lei Zhang1, Junjie Fang1

  • 1Department of Vascular Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China (Xia, Zhang, Fang, Shu, J. Li, and X. Li); The Institute of Vascular Diseases, Central South University, Changsha, Hunan 410011, China (Xia, Zhang, Fang, Shu, J. Li, and X. Li).

Journal of Clinical Lipidology
|July 29, 2026
PubMed

Insights

Elevated Lipoprotein(a) [Lp(a)] is linked to increased risk of aortic aneurysm and dissection (AA/AD). This study confirms Lp(a) as a potential biomarker for aortic diseases, particularly abdominal aortic aneurysm (AAA).

Area of Science:

  • Cardiovascular Research
  • Genetics and Genomics
  • Vascular Biology

Background:

  • Aortic aneurysm and dissection (AA/AD) are severe vascular conditions with limited treatment options.
  • Lipoprotein(a) [Lp(a)] is a genetically influenced factor implicated in atherosclerosis, but its causal role in AA/AD requires robust evidence.

Purpose of the Study:

  • To examine the association between Lp(a) levels and the risk of AA/AD.
  • To investigate the potential causal relationship between Lp(a) and specific aortic disease subtypes using Mendelian randomization (MR).

Main Methods:

  • Analysis of a large prospective cohort (312,332 participants) from the UK Biobank.
  • Utilized survival analyses (Kaplan-Meier, Cox regression, competing-risk models) to assess Lp(a) associations.
  • Employed two-sample MR analyses to evaluate causal effects on aortic aneurysm (AA) and dissection (AD), including abdominal aortic aneurysm (AAA) and thoracic aortic aneurysm (TAA).

Main Results:

  • Higher Lp(a) levels were independently associated with increased AA/AD risk in a dose-dependent manner.
  • MR analyses indicated a causal link between Lp(a) and overall AA (OR=1.31) and AAA (OR=1.80).
  • Evidence for a causal association between Lp(a) and TAA or AD was not statistically significant, potentially due to limited power.

Conclusions:

  • Lp(a) shows promise as a biomarker for assessing and stratifying risk in patients with aortic diseases.
  • Further research is needed to clarify the clinical utility of Lp(a) measurement, especially for AD, given the limitations in current MR analysis.
Abstract

Keywords:
Aortic aneurysmAortic dissectionLipoprotein(a)Mendelian randomizationUK Biobank

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