What question did this study set out to answer?

The study aims to characterize risk factors and management of patients with elevated lipoprotein(a).

February 8, 2026

Design and initial results of the Canadian lipoprotein(a) registry

LBL R BrunhamUniversity of British Columbia AKA KramerUniversity of British Columbia IIIulia IatanUniversity of British Columbia

Key Points

The study aims to characterize risk factors and management of patients with elevated lipoprotein(a).
Prospective, longitudinal observational design
Inclusion of patients with Lp(a) ≥100 nmol/L
Data collection includes demographics, lab values, medications, and cardiovascular outcomes
Patients followed annually after enrollment starting June 2024
93 patients enrolled by February 2025, with a median Lp(a) level of 225 nmol/L
50.5% of patients were male, with a mean age of 57.1 years
36.6% had familial hypercholesterolemia, and 19.4% had a history of myocardial infarction
79.6% were on lipid-lowering therapies, but 20% were not receiving any at enrollment

Abstract

Abstract Background Lipoprotein(a) Lp(a) is a genetically determined independent risk factor for atherosclerotic cardiovascular disease (ASCVD). Multiple guidelines recommend universal testing of Lp(a) once in an individual’s lifetime, and intensification of risk factor management in individuals with elevated Lp(a). However, there are limited data about how Lp(a) levels are being used in clinical practice. Purpose The Canadian Lp(a) Registry is designed to characterize the risk factors, management, and outcomes of patients with elevated Lp(a). Here we report the design and preliminary characteristics of patients enrolled in the registry. Methods The Canadian Lp(a) Registry is a prospective, longitudinal observational study including participating sites throughout Canada. Enrolment began in June 2024 and the inclusion criterion is Lp(a) ≥100 nmol/L (50 mg/dL). Data are collected at baseline and at annual follow-up, and include patient demographics, risk factors, lab values, imaging tests, medications, and cardiovascular outcomes. Results A total of 93 patients were enrolled in the registry as of February 2025, 47 (50.5%) of whom were male (Table 1). The mean age was 57.1±13.0 years. The median Lp(a) level was 225 (IQR 186-346) nmol/L. The mean number of Lp(a) measurements per patient was 2.0±1, with 48 (51.6%) having more than 1 lifetime measurement of Lp(a). Probable or definite familial hypercholesterolemia was present in 36.6%. The mean low-density lipoprotein cholesterol (LDL) was 2.31 ± 1.58, with most patients (79.6%) being on lipid-lowering therapies. These included statins (75.3%), ezetimibe (47.3%), and PCSK9 inhibitors (34.4%). Many patients (53.8%) were taking multiple lipid-lowering therapies. Cardiovascular disease at the time of enrollment in the registry included 18 (19.4%) patients with prior myocardial infarction, 31 (33.3%) with prior coronary revascularization, and 4 (4.3%) who had a previous stroke or transient ischemic attack. A history of severe aortic stenosis was present in 4 (4.3%) patients. Conclusions The Canadian Lp(a) Registry is a prospective observational study designed to generate real world evidence regarding the clinical management and cardiovascular outcomes for patients with elevated Lp(a). Preliminary results from the baseline characteristics of the registry indicate this is a high-risk population, with many patients having pre-existing ASCVD or familial hypercholesterolemia. However, 1 in 5 patients with elevated Lp(a) were not taking any lipid-lowering therapy at the time of enrolment. Repeat testing of Lp(a) levels was common and could suggest uncertainty among care providers about how to use Lp(a) testing. Future results from this registry will help improve understanding of how Lp(a) levels are being used as part of routine clinical practice and to identify opportunities to optimize the quality of care of this population.Table 1

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