Title
Real-world association between elevated lipoprotein (a) and cerebrovascular and cardiovascular outcomes: A federated EHR cohort study
Authors
Meet P. Kachhadia1, Piyush Puri2, Gaurang H. Suhagiya3, Sarah Meadows1, Usmaan Topiwala4, Juber D. Shaikh5, Marc A. Swerdloff6, Nirali Borad7, Gurnoor Gill1, Jay Patel8, Samarth Shah9 & Harshal A. Sanghvi10,*
Affiliation
1Department of Medicine, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA; 2Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, NYC Health + Hospitals/Queens, New York, NY, USA; 3Department of Cardiology, Jiangsu University, China; 4Department of Medicine, Smt. NHL Municipal Medical College, Ahmedabad, Gujarat, India; 5Department of Medicine, Henry Ford Health System, Detroit, MI, USA; 6Department of Neurology, Marcus Neuroscience Institute, Boca Raton Regional Hospital, Boca Raton, FL, USA; 7Department of Medicine, Thomas Memorial Hospital, South Charleston, WV, USA; 8Department of Biomedical Engineering, Florida Atlantic University, Boca Raton, FL, USA; 9Department of Technology and Clinical Trials, Advanced Research LLC, FL, USA; 10Department of Information Technology and Operations Management, College of Business, Florida Atlantic University, Boca Raton, FL, USA; *Corresponding author
Meet P. Kachhadia - E-mail: mkachhadia@health.fau.edu
Piyush Puri - E-mail: puri.piyush777@gmail.com
Gaurang H. Suhagiya - E-mail: gaurangsuhagiya1996@gmail.com
Sarah Meadows - E-mail: meadows.sarahb@gmail.com
Usmaan Topiwala - E-mail: usmaantopiwala@gmail.com
Juber D. Shaikh - E-mail: jubershaikh703@yahoo.com
Marc A. Swerdloff - E-mail: mswerdloff@baptisthealth.net
Nirali Borad - E-mail: niraliborad@gmail.com
Gurnoor Gill - E-mail: ggill2023@health.fau.edu
Jay Patel - E-mail: jay16501@gmail.com
Samarth Shah - E-mail: samarthshah341@gmail.com
Harshal A. Sanghvi - E-mail: hsanghvi2020@fau.edu
Article Type
Research Article
Date
Received August 1, 2026; Revised August 31, 2026; Accepted August 31, 2026, Published August 31, 2026
Abstract
Elevated lipoprotein(a) (Lp(a)) is a causal cardiovascular risk factor, yet its association with incident ischemic stroke in routine clinical care remains uncertain. Adults in the TriNetX US Collaborative Network with Lp(a) ≥50 mg/dL were compared with those having Lp(a) <50 mg/dL after 1:1 propensity score matching. Among 97,882 matched adults, incident ischemic stroke or transient ischemic attack occurred in 2.45% versus 2.69% (hazard ratio 0.956, 95% CI 0.878–1.041; p=0.299). Alternative-cutoff, dose-response and landmark analyses were uniformly null and only a post-hoc composite adding myocardial infarction reached nominal significance (hazard ratio 1.058, 1.004–1.116). Thus, real-world stroke risk in patients with elevated Lp(a) appears attenuated by testing-indication bias and intensified preventive management.
Keywords
Lipoprotein (a) (Lp(a)), ischemic stroke, cardiovascular outcomes, propensity score matching, dose-response, federated electronic health records
Citation
Kachhadia et al. Bioinformation 22(8): 4787-4792 (2026)
Edited by
P Kangueane
ISSN
0973-2063
Publisher
License
This is an Open Access article which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. This is distributed under the terms of the Creative Commons Attribution License.
