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Thromb Haemost
DOI: 10.1055/a-2674-5114
Review Article

Lipoprotein(a) and Venous Thromboembolism: Association, Causality, and Medications

Mariana B. Pfeferman
1   Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Sina Rashedi
1   Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Gregory Y. H. Lip 
2   Liverpool Centre for Cardiovascular Science at the University of Liverpool, Liverpool John Moores University, and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
3   Department of Clinical Medicine, Danish Center for Health Services Research, Aalborg University, Aalborg, Denmark
,
Christian Weber
4   Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-Universität (LMU), LMU University Hospital, Munich, Germany
,
Michelle L. O'Donoghue
5   Cardiovascular Division, TIMI Study Group, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Steven Nissen
6   Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, United States
,
Stephen J. Nicholls
7   Victorian Heart Institute, Monash University, Clayton, Melbourne, Australia
,
Pradeep Natarajan
8   Department of Cardiovascular Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States
,
Jorge Plutzky
9   Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Peter Libby
9   Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Samuel Z. Goldhaber
1   Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
9   Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Gregory Piazza
1   Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
9   Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Behnood Bikdeli
1   Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
9   Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
10   YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, United States
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Abstract

Lipoprotein(a) [Lp(a)] is a circulating plasma lipoprotein with structural similarities to low-density lipoprotein (LDL), distinguished by the addition of apolipoprotein(a) to the LDL structure. Lp(a) levels are approximately 80% genetically determined, and distinct components of this complex particle are thought to confer atherogenic, inflammatory, and antifibrinolytic properties contributing to cardiovascular risk. A growing body of evidence has shown a causal association between elevated Lp(a) levels and both atherosclerotic cardiovascular disease (ASCVD) and valvular aortic stenosis. However, the link with venous thromboembolism (VTE) (encompassing deep vein thrombosis [DVT] and pulmonary embolism [PE]) has been less clear. Although in vitro studies suggest antifibrinolytic and prothrombotic properties for Lp(a), clinical and genetic studies have yielded inconsistent results related to thrombogenicity, with some studies suggesting an association with VTE only with very high Lp(a) levels. The effect of Lp(a) levels on outcomes in patients with incident VTE has not been comprehensively investigated. Although there are currently no approved therapies specifically targeting Lp(a) reduction, at least five agents are in development, with preliminary data demonstrating reductions in Lp(a) levels of up to 98%. The impact of these therapies on VTE events remains unknown. In turn, other lipid-modifying agents, which have no effect on reducing Lp(a), such as statins, were shown to reduce incident VTE. This review summarizes the current evidence regarding the association between Lp(a) and VTE, focusing on its pathophysiology and critically analyzing the existing evidence from experimental, epidemiological, and genetic studies.

Keywords

lipoprotein(a) - apolipoprotein(a) - venous thromboembolism - deep vein thrombosis - pulmonary embolism - thrombosis

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Eingereicht: 24. Mai 2024

Angenommen: 01. August 2025

Artikel online veröffentlicht:
22. August 2025

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