J Clin Lipidol. 2026 Jul 10:S1933-2874(26)00442-3. doi: 10.1016/j.jacl.2026.07.014. Online ahead of print.
ABSTRACT
BACKGROUND: Aortic aneurysm and dissection (AA/AD) are life-threatening vascular diseases with high mortality, yet no effective drugs to delay progression. Lipoprotein(a) [Lp(a)] is genetically determined and associated with atherosclerotic disease, but high-quality evidence on its causal role in AA/AD remains limited.
OBJECTIVE: To investigate the association between Lp(a) and AA/AD and assess potential causal relationships with major aortic disease subtypes.
METHODS: A prospective cohort of 312,332 UK Biobank participants was analyzed. Kaplan-Meier curves, Cox regression, and Fine-Gray competing-risk models assessed associations between Lp(a) and incident AA/AD. Two-sample Mendelian randomization (MR) analyses evaluated the potential causal effects of Lp(a) on AA, abdominal aortic aneurysm (AAA), thoracic aortic aneurysm (TAA), and AD.
RESULTS: During a median follow-up of 16.5 years, 3122 AA/AD events occurred. Elevated Lp(a) independently predicted AA/AD with a dose-response relationship (hazard ratio [HR] = 1.40 for >180 vs <50 nmol/L; HR = 1.15 per 75 nmol/L increment). Competing-risk analyses yielded consistent results. MR analyses supported a causal association between Lp(a) and AA (odds ratio [OR] = 1.31, 95% CI: 1.08-1.62) and AAA (OR = 1.80, 95% CI: 1.37-2.37), whereas MR analyses did not provide sufficient evidence for causal associations with TAA or AD.
CONCLUSION: Lp(a) may serve as a promising biomarker for risk assessment and stratification in aortic disease. However, the MR analysis for AD was limited by low statistical power, and the clinical utility of Lp(a) measurement requires further investigation.
PMID:42527266 | DOI:10.1016/j.jacl.2026.07.014