Real-world association between elevated lipoprotein (a) and cerebrovascular and cardiovascular outcomes: A federated EHR cohort study

Abstract

Elevated lipoprotein(a) (Lp(a)) is a causal cardiovascular risk factor, yet its association with incident ischemic stroke in routine clinical care remains uncertain. Adults in the TriNetX US Collaborative Network with Lp(a) ≥50 mg/dL were compared with those having Lp(a) <50 mg/dL after 1:1 propensity score matching. Among 97,882 matched adults, incident ischemic stroke or transient ischemic attack occurred in 2.45% versus 2.69% (hazard ratio 0.956, 95% CI 0.878–1.041; p=0.299). Alternative-cutoff, dose-response and landmark analyses were uniformly null and only a post-hoc composite adding myocardial infarction reached nominal significance (hazard ratio 1.058, 1.004–1.116). Thus, real-world stroke risk in patients with elevated Lp(a) appears attenuated by testing-indication bias and intensified preventive management.