Association between lipoprotein(a) and autoimmune inflammatory diseases

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Created On: 25/02/2026

Lipoprotein(a) [Lp(a)] is a well-established, genetically determined cardiovascular (CV) risk factor and a major determinant of atherosclerotic cardiovascular disease (ASCVD).

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Key take away

Patients with autoimmune or inflammatory diseases have markedly elevated lipoprotein(a) levels, comparable to those with established ASCVD.

Background

Lipoprotein(a) [Lp(a)] is a well-established, genetically determined cardiovascular (CV) risk factor and a major determinant of atherosclerotic cardiovascular disease (ASCVD). Separately, autoimmune and inflammatory diseases (AIIDs) are linked with accelerated atherosclerosis and excess CV mortality. Chronic systemic inflammation may amplify Lp(a) concentrations, potentially linking immune-mediated disease activity with heightened CV risk; however, this link remains poorly characterized at the population level.

This study examined the connection between Lp(a) levels and 6 common autoimmune or inflammatory diseases—systemic lupus erythematosus, rheumatoid arthritis, psoriasis or psoriatic arthritis, ankylosing spondylitis, inflammatory bowel disease, and gout—and to determine whether AIIDs confer a higher risk of markedly elevated Lp(a) independent of traditional CV risk factors.

Method

This retrospective multicenter cohort study was carried out using electronic health record data from five University of California Medical Centers. Adults with at least one Lp(a) measurement procured during routine clinical care were classified into three groups: patients with an AIID, patients with ASCVD without AIIDs, and individuals without AIIDs or ASCVD. Multivariable logistic regression was used to estimate adjusted odds ratios for elevated Lp(a) (>70 mg/dL), controlling for age, gender, body mass index, and race/ethnicity.

Result

Among 49,503 adults included in the analysis, 8,073 had an autoimmune or inflammatory disease, 19,279 had ASCVD, and 28,844 served as controls. Within the AIID group, gout was the most prevalent ailment, followed by ankylosing spondylitis, psoriasis or psoriatic arthritis, rheumatoid arthritis, inflammatory bowel disease, and systemic lupus erythematosus.

The cohort had a mean age of 56 years, with nearly half being women and broad racial and ethnic diversity. Elevated Lp(a) levels (>70 mg/dL) were present in over one-fifth of patients with AIIDs, a prevalence comparable to that observed in those with established ASCVD and substantially higher than in those without AIIDs or ASCVD. After multivariable adjustment, AIID status was independently linked with a 43% higher likelihood of markedly elevated Lp(a) compared with controls.

Conclusion

AIIDs were independently linked with markedly elevated Lp(a) levels, approaching the burden observed in those with established ASCVD. These findings suggest that Lp(a) may represent a key, underrecognized mediator of CV risk in immune-mediated inflammatory diseases and support consideration of Lp(a) screening and targeted CV risk assessment in this high-risk population.