Increased Stroke Risk and Lipoprotein(a) in a Multiethnic Community: The Northern Manhattan Stroke Study

Most early lipoprotein(a) research was done in white populations, leaving open whether its risks applied across racial and ethnic groups. This study from northern Manhattan deliberately looked at a diverse urban community.

Comparing stroke cases with controls among White, Black, and Hispanic residents, the investigators found that elevated Lp(a) was independently associated with ischemic stroke, with levels at or above 30 mg/dL raising risk about 1.8-fold in a dose-dependent way. The association was strongest among Black participants and among men. It extended the Lp(a)-stroke link into populations where it had been understudied.

The finding carries an important nuance the field has since sharpened: because Lp(a) levels and their relationship to risk can vary by ancestry, race-based thresholds proved problematic, and current guidance has moved away from them. This study’s value is in demonstrating that elevated Lp(a) matters across groups, even as the details of how to define “elevated” continue to be refined.

We rate the evidence moderate. As a case-control study of modest size it shows association rather than causation, but it usefully broadened the evidence base beyond the populations where Lp(a) was first studied.