LIPOPROTEIN (a) IN STROKE: FROM PATHOPHYSIOLOGY TO EMERGING THERAPEUTIC POSSIBILITIES

Mikołaj Góralczyk; Martyna Grześkowiak; Julita Jagodzińska; Agata Juchniewicz; Maria Bieske; Iga Kuba; Anna Lubomska; Jakub Sapikowski; Jakub Idziński; Igor Jętasiewicz

doi:10.31435/ijitss.2(50).2026.5664

Authors

Mikołaj Góralczyk The Baptism of Poland Memorial Hospital in Gniezno, Św. Jana 9 street, 62-200 Gniezno, Poland https://orcid.org/0009-0009-2733-1428
Martyna Grześkowiak Florian Ceynowa Specialist Hospital in Wejherowo, Dr A. Jagalskiego 10 street, 84-200 Wejherowo, Poland https://orcid.org/0009-0003-8434-4870
Julita Jagodzińska Maria Skłodowska-Curie Provincial Specialist Hospital in Zgierz, Parzęczewska 35 street, 95-100 Zgierz, Poland https://orcid.org/0009-0004-9403-9850
Agata Juchniewicz 7th Naval Hospital in Gdańsk, Polanki 117 street, 80-305 Gdańsk, Poland https://orcid.org/0009-0009-4014-3413
Maria Bieske Dr Rafał Masztak Grochowski Hospital, Grenadierów 51/59 street, 04-073 Warsaw, Poland https://orcid.org/0009-0008-6704-8742
Iga Kuba Pabianice Medical Centre, Jana Pawła II street, 95-200 Pabianice, Poland https://orcid.org/0009-0001-5834-9075
Anna Lubomska Independent Public Multispecialist Healthcare Centre of the Ministry of Internal Affairs and Administration in Bydgoszcz, Ks. Ryszarda Markwarta 4-6 street, 85-015 Bydgoszcz, Poland https://orcid.org/0009-0003-7820-7669
Jakub Sapikowski 7th Naval Hospital in Gdańsk, Polanki 117 street, 80-305 Gdańsk, Poland https://orcid.org/0009-0008-7253-514X
Jakub Idziński Independent Public Multispecialist Healthcare Centre of the Ministry of Internal Affairs and Administration in Bydgoszcz, Ks. Ryszarda Markwarta 4-6 street, 85-015 Bydgoszcz, Poland https://orcid.org/0009-0006-1058-9615
Igor Jętasiewicz Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland https://orcid.org/0009-0008-3351-6392

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.5664

Keywords:

Lipoprotein (a), Stroke, Stroke Prevention, LPA gene, RNA-based therapy, ASO

Abstract

Background: Lipoprotein(a) [Lp(a)] is a genetically determined lipoprotein increasingly recognized as an independent cardiovascular risk factor. Its role in ischemic stroke has gained attention, although its clinical relevance remains incompletely defined.

Objective: To summarize current evidence on the role of Lp(a) in stroke pathophysiology, its diagnostic value, and therapeutic possibilities.

Materials and Methods: A systematic review of literature published between 2016 and 2026 was conducted using PubMed, Web of Science, and Google Scholar. Meta-analyses, cohort studies, clinical trials, and guideline-based publications addressing Lp(a) and stroke were included.

Results: Elevated Lp(a) levels are associated with an increased risk of ischemic stroke, supported by observational studies and meta-analyses. This relationship is largely driven by proatherogenic, proinflammatory, prothrombotic, and antifibrinolytic mechanisms. Lp(a) levels are strongly genetically determined, primarily by LPA gene variants. Evidence does not support a significant association between Lp(a) and hemorrhagic stroke. Therapeutic options remain limited, as standard lipid-lowering therapies have minimal impact on Lp(a). PCSK9 inhibitors provide modest reductions, while novel RNA-based therapies show substantial Lp(a) lowering, though their clinical benefit in stroke prevention is yet to be confirmed.

Conclusions: Lp(a) is an important but underutilized marker of ischemic stroke risk. Further studies are needed to establish the clinical effectiveness of targeted therapies and to refine its role in routine risk assessment.

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