Lipoprotein(a) is Independently Associated with Polyvascular Disease Burden

Lipoprotein(a) [Lp(a)] is an established, genetically determined risk factor for atherosclerotic cardiovascular disease. However, its association with the polyvascular disease burden remains unclear. This study investigated the relationship between the Lp(a) concentration and polyvascular disease burden.

We retrospectively analyzed data from 1,799 patients who underwent Lp(a) measurements between 2012 and 2025. The polyvascular disease burden was assessed using a polyvascular score based on the presence of coronary artery disease, cerebrovascular disease, lower-extremity artery disease, aneurysmal aortic disease, and calcific aortic valve disease. Patients were categorized according to the number of affected disease domains (scores 0, 1, 2, 3, and ≥ 4). A multivariable ordinal logistic regression analysis was performed to identify the factors associated with an increasing polyvascular disease burden.

Patients with polyvascular disease (polyvascular score ≥1) had significantly higher Lp(a) concentrations than those without clinically overt vascular disease (57.9 [24.0-118.3] vs. 42.9 [20.2-76.8] nmol/L, P＜0.001). The Lp(a) concentrations increased progressively with increasing polyvascular scores, and the prevalence of elevated Lp(a) (≥ 125 nmol/L) increased stepwise across the score categories (both P＜0.001). In a multivariable ordinal logistic regression analysis adjusted for age, sex, hypertension, smoking history, family history of ischemic heart disease, eGFR, and LDL-C, higher Lp(a) levels remained independently associated with an increased polyvascular disease burden (OR 1.07 per 10 nmol/L increase, 95% CI 1.05-1.10; P＜0.001).

Higher Lp(a) concentrations were independently associated with an increased polyvascular disease burden, suggesting that Lp(a) may reflect the extent of cardiovascular disease involvement across multiple disease domains.