Key result
Aspirin may lower cardiovascular events in primary prevention patients with very high Lp(a).
Why the study?
There are no approved therapies specifically indicated to lower elevated lipoprotein(a), and recent evidence suggests aspirin may reduce cardiovascular events in primary prevention for patients with high Lp(a).
Does aspirin reduce cardiovascular events in primary prevention in patients with high lipoprotein(a)?
Does aspirin reduce cardiovascular events in primary prevention in patients with high lipoprotein(a)?
Aspirin may serve as a transitional primary prevention strategy to reduce cardiovascular events in select high-risk patients with very high Lp(a) while awaiting targeted RNA-based therapies.
May support aspirin consideration in high Lp(a); leaves open whether RCTs confirm net benefit.
Elevated lipoprotein(a) [Lp(a)] is a genetically determined cardiovascular risk factor, linked to both atherosclerotic cardiovascular disease and aortic valve stenosis. Plasma Lp(a) levels between 30-50mg/dL suggest a moderate risk, while levels of 51-180mg/dL indicate high risk, and concentrations exceeding 180mg/dL are linked to a very high cardiovascular risk. Currently, there are no approved therapies specifically indicated to lower Lp(a). Recent evidences indicate a role of aspirin in reducing cardiovascular events in primary prevention in patients with high Lp(a). In this review, we discuss the results of the studies that explored the impact of aspirin in reducing cardiovascular events in primary prevention in patients with increased Lp(a) while waiting for the results from large-scale research initiative exploring the impact of RNA-targeting Lp(a)-lowering therapies in reducing cardiovascular risk. In conclusion, waiting for the ongoing trials on emerging RNA-based therapies, the use of aspirin in a subgroup of patients with high atherosclerotic cardiovascular risk, with very high Lp(a) levels and without important bleeding risk could be an interesting strategy. Emerging RNA-targeted therapies might offer in future increased protection against the occurrence of major atherosclerotic cardiovascular events compared to standard lipid management agents in these patients.
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Vittone et al. (2026) conducted a review in High lipoprotein(a). Aspirin was evaluated on cardiovascular events. Aspirin may be a useful primary prevention strategy to reduce cardiovascular events in patients with very high lipoprotein(a) levels and low bleeding risk, pending new therapies.
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