Compared with those with Lp(a) <10 mg/dL, the incidence of ischemic stroke was 2.12-fold greater (RR, 2.12; 95% CI, 1.48 3.03) in blacks with Lp(a) >30 mg/dL. In whites, it was 1.65-fold greater (RR 1.65; Several studies have found Lp(a) level to be associated with the severity of carotid artery stenosis and One study found that Lp(a) levels were higher in patients with strokes related to large-vessel atherothrombotic disease than in patients with lacunar strokes.808 A meta-analysis of 31 studies comprising 56010 subjects found that Lp(a) was higher in stroke patients and that incident stroke was 22% (RR, 1.22; 95% CI, 1.04 1.43) more frequent in patients in the high- est compared with the lowest tertile of Lp(a).809 A recent study assessing the value of emerging circulating lipid markers such as Lp(a) for the prediction of first cardio- vascular events showed that the addition of information on Lp(a) to that on conventional risk factors such as total and HDL cholesterol slightly improved the prediction of cardio- vascular events and would reclassify 4% of individuals to a 20% predicted risk of having a cardiovascular event within 10 years and therefore needing statin treatment according to Adult Treatment Panel III guidelines.810 A meta-analysis of observational studies reported an asso- ciation of elevated Lp(a) with first childhood arterial ischemic More recently, ele- vated Lp(a) was also associated with recurrent arterial isch- emic stroke in children.812 Niacin decreases Lp(a) levels.813 In a meta-analysis of sec- ondary prevention trials including a total of 9959 subjects, niacin treatment yielded relative odds reductions of 34% of any CVD event (P=0.007).173 However, no significant effect of niacin on stroke was observed. Lp(a): Summary and Gaps Elevated Lp(a) is associated with a higher risk of stroke. 