ISC 2026 | Lipoprotein(a) in stroke and TIA: who should be tested?

LP(a), or lipoprotein(a), is often thought of as a cardiovascular risk factor, but we’re increasingly noticing that it’s associated with other atherothrombotic events, including stroke and TIA. So I think that increasing awareness, especially amongst neurologists who are often dealing with these conditions, can help unmask the true prevalence and severity of Lp(a)’s contribution to these diseases. Lp(a) is important because although it looks a lot like LDL, which we know is a stroke risk factor, Lp(a) is six times more likely to be atherogenic on a particle-by-particle basis compared to LDL. So it’s much more potent, and it’s often under-recognized, especially in families who share similar risk profiles towards stroke. In terms of neurologists and when to consider looking for Lp(a), in particular, Lp(a) is associated with patients who have stroke at an early age, so before 60 years having a stroke or a TIA. Patients who have recurrent stroke despite having optimal other risk factors, so especially in that circumstance where LDL may appear normal, but they still have a stroke or another stroke after initial control. And finally, in patients who have cryptogenic stroke where it’s unclear exactly what their risk might be, the Lp(a) might help unmask things that we can help modify.

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