Physicians' Academy for Cardiovascular Education

Elevated Lp(a) associated with large artery atherosclerosis stroke and risk of recurrent stroke

Lipoprotein(a) is associated with large artery atherosclerosis stroke aetiology and stroke recurrence among patients below the age of 60 years: results from the BIOSIGNAL study

Literature - Arnold M, Schweizer J, Nakas CT et al. - Eur Heart J. 2021 Mar 8;ehab081. doi: 10.1093/eurheartj/ehab081.

Introduction and methods

Up to 25% of strokes are recurrent strokes which are more likely to be fatal or lead to disability compared to first strokes [1]. Optimal secondary prevention depends on the underlying etiology of the stroke. However, the underlying etiology remains undetermined in approximately 30% of cases [2]. Especially in a younger population, recognized vascular risk factors may not have developed yet but so far unknown risk factors may play a role in the development of stroke. There is a growing body of evidence that Lp(a) is causally associated with ASCVD [3-9]. However, evidence of the association of Lp(a) with stroke recurrence or stroke etiology is scarce. This study investigated the association of Lp(a) with large artery atherosclerosis (LAA) stroke and risk of recurrent cerebrovascular events (acute ischemic stroke [AIS] or TIA) within 1 year after index AIS.

BIOSIGNAL is a prospective, observational, multicenter cohort study to evaluate selected blood biomarkers in 1759 patients with AIS. Blood biomarkers were measured within 24h from symptom onset. Median age was 74 (IQR 64–82) years, 342 (19.4%) participants were <60 years, 736 (42%) were female and 1711 (98.6%) were Caucasian. Outcomes were LAA stroke according to the TOAST (Trial of Org 10172 in Acute Stroke Treatment) [10] and CCS (Causative Classification System) [11] classification on hospital discharge and time to recurrent ischemic cerebrovascular event (AIS or TIA) during 1-year follow-up after the index stroke.

Main results


Elevated Lp(a) was independently associated with LAA stroke etiology and risk of recurrent AIS or TIA in patients <60 years.


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Find this article online at Am Heart J.

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