Abstract WP125: Lipoprotein(a) and Echocardiographic Findings in Ischemic Stroke: Aortic Plaque as a Potential Signal

Background: Lipoprotein(a) [Lp(a)] is a genetically determined, pro-atherogenic lipoprotein associated with ischemic stroke risk. While both Lp(a) and aortic arch plaque are established stroke risk factors, no studies have directly examined the relationship between Lp(a) levels and aortic arch plaque presence or characteristics in ischemic stroke patients. Aortic arch plaque is an established embolic source, but its relationship with Lp(a) levels in stroke patients has not been examined. Methods: We analyzed 188 consecutive ischemic stroke patients (2024–2025) from the Mount Sinai Health System Get With The Guidelines–Stroke registry with documented Lp(a) levels and echocardiographic evaluations. We abstracted patient demographics, including sex, age, race, and past medical history. Echocardiogram findings included ejection fraction (EF), aortic plaque, aortic stenosis, and left atrial enlargement. We additionally abstracted stroke subtype, as defined by TOAST classification. Based on previously established methods in Lp(a) research, patients were stratified by cohort-based Lp(a) tertiles (≤65, >65–165, >165 nmol/L). We compared echocardiographic findings and TOAST stroke subtypes across Lp(a) groups. Kruskal-Wallis and chi-square/Fisher’s tests were used for group comparisons. Results: Median age was 68.5 years (IQR 61–78), 45.7% were female, and median Lp(a) was 100 nmol/L (IQR 56–188). Race distribution significantly differed across Lp(a) tertiles ( p =0.008). Black patients comprised 39.7% of the lowest tertile, 70.5% of the middle tertile, and 66.1% of the highest tertile, despite representing 58.0% of the overall cohort. Eighteen (9.6%) patients had aortic arch plaque, which was more common in the highest Lp(a) tertile (17.5%) than in the middle (8.1%) or lowest (3.2%) ( p =0.02). Other echocardiographic findings and stroke subtype did not differ by Lp(a) tertile. Conclusions: In this cohort of ischemic stroke patients, higher Lp(a) was associated with the presence of aortic arch plaque on echocardiography. Although there was no difference in stroke subtype, aortic arch plaque may be an underrecognized source of stroke in patients with elevated Lp(a) and may provide further support for efforts to aggressively modify the atherosclerotic risk factor profile in these patients.