ABSTRACT NUMBER: ESOC2026A55 ELEVATED LIPOPROTEIN(A) AND RISK OF YOUNG-ONSET ISCHEMIC STROKE: A PROPENSITY SCORE-MATCHED CASE-CONTROL STUDY

Abstract Background and aims Lipoprotein(a) [Lp(a)] is an established cardiovascular risk factor, but its contribution to young-onset ischemic stroke remains incompletely defined. We investigated the association between elevated Lp(a) levels and ischemic stroke in young adults. Methods In this case–control study, patients with ischemic stroke (n=212) aged 18–60 years were compared with healthy controls (n=1,782). Propensity score matching for age, sex, and race yielded 158 matched pairs. Lp(a) was measured and classified as elevated (≥70 nmol/L) or normal (<70 nmol/L). Conditional logistic regression analyses were performed to examine associations between elevated Lp(a) and stroke, adjusting for traditional vascular risk factors. Results After propensity score matching, cases and controls were well balanced for age (47.1±8.7 vs 47.3±8.7 years), sex (77.9% vs 77.2% male), and race. Ischemic stroke patients had higher mean Lp(a) levels (65.5±78.0 vs 35.4±58.8 nmol/L; p<0.001) and a greater prevalence of elevated Lp(a) (28.5% vs 11.4%; p<0.001) compared to healthy controls. Elevated Lp(a) was strongly associated with ischemic stroke in univariable analysis (OR 3.10, 95% CI 1.73–5.76; p<0.001) and remained independently associated after adjustment for hypertension, diabetes mellitus, smoking, and obesity (OR 2.73, 95% CI 1.06–7.02; p=0.038). Conclusions Elevated Lp(a) is independently associated with an approximately three-fold increased risk of young-onset ischemic stroke. These findings highlight Lp(a) as a potentially important and under-recognised risk factor in young stroke and support further evaluation of Lp(a)-targeted screening and therapeutic strategies. Conflict of interest Cherie YT Ong, Loh Wann Jia, Tan Yong Yi, Ching-Hui Sia, Leonard LL Yeo, Troy Puar, Benjamin YQ Tan: nothing to disclose Table 1 - belongs to Results Table 2 - belongs to Results Figure 1 - belongs to Results Figure 2 - belongs to Results