Lipids & metabolic liver disease
Lipoprotein(a), insulin resistance, and cardiovascular outcomes in metabolic dysfunction-associated steatotic liver disease
Authors' conclusion
Elevated Lp(a) and IR were independently associated with adverse cardiovascular outcomes in MASLD, with the highest risk observed among individuals with concomitant elevations in both markers.
Study context
- Population
- Adults with MASLD in the UK Biobank; Insulin resistance (IR) assessed by the triglyceride-glucose (TyG) index94,089 without baseline cardiovascular disease (CVD)
- Participants
- 101,348 adults
- Exposure
- Joint Lp(a)/IR categories (Lp(a) <125 vs ≥125 nmol/L; TyG index low vs high, by 75th percentile)
- Outcome
- Incident CVD and CVD mortality
- Follow-up
- Median 15.7 years
Methodological detailsUK Biobank, Cox proportional hazards models, fully adjusted model
- UK Biobank
- Cox proportional hazards models
- Fully adjusted model
Main finding
As reported in the abstract
Estimate (95% CI)P value
Elevated Lp(a)/high IRvs Low Lp(a)/low IR
adjusted HR (CVD mortality) 2.04(1.63–2.55)
P < 0.001Elevated Lp(a)/high IRvs Low Lp(a)/low IR
adjusted HR (incident CVD) 1.49(1.35–1.64)
P < 0.001Lp(a), per SD increasefully adjusted model
HR (CVD mortality) 1.14(1.10–1.19)
P < 0.001Lp(a), per SD increasefully adjusted model
HR (incident CVD) 1.09(1.07–1.11)
P < 0.001TyG, per SD increasefully adjusted model
HR (CVD mortality) 1.27(1.21–1.34)
P < 0.001TyG, per SD increasefully adjusted model
HR (incident CVD) 1.09(1.07–1.12)
P < 0.001- Dose-response trend across joint Lp(a)/IR groups
- P for trend < 0.001
Observational data: associations, not effects.
Further findings
Subgroups by age, sex, obesity, diabetes and hypertension
- Associations remained consistent across subgroups
Original publication
Lipoprotein(a), insulin resistance, and cardiovascular outcomes in metabolic dysfunction-associated steatotic liver disease. Cardiovasc Diabetol. Published 17 July 2026. doi:10.
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