Menopausal status, hormonal therapy, and elevated lipoprotein(a): Implications for prevalent coronary artery disease in U.S. Women Veterans
*Correspondence to:
Shriram Nallamshetty, VA Palo Alto Healthcare System, Palo Alto, California 94304, USA; Division of Cardiovascular Medicine, Stanford School of Medicine, Stanford, California 94305, USA.
E-mail: shriram.nallamshetty@va.gov
Adv Lipoprotein(a) Res. 2026;1:202610. 10.70401/alr.2026.0012
Received: May 27, 2026Accepted: October 23, 2026Published: October 27, 2026
This manuscript is made available in its unedited form to allow early access to the
reported findings. Further editing will be completed before final publication. As
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Abstract
Aim: To determine whether menopausal status, menopausal hormone therapy (MHT), or oral contraceptive (OCP) use modifies the association between elevated Lp(a) and prevalent coronary artery disease (CAD).
Methods: We conducted a cross-sectional study of 6,314 U.S. Women Veterans with Lp(a) testing from 1999-2025 to evaluate whether menopausal status, MHT use, or OCP use modify the association between elevated Lp(a) (≥ 125 nmol/L) and prevalent CAD. Logistic regression was used to estimate adjusted odds ratios (aOR), with interaction terms evaluated by likelihood ratio tests. Restricted cubic splines were used to model the continuous association between Lp(a) and prevalent CAD.
Results: Elevated Lp(a) was present in 31.6% of Women Veterans and was independently associated with increased odds of prevalent CAD (aOR 1.24, 95% confidence interval 1.06-1.44, p = 0.0079). We observed a continuous increase in prevalent CAD with rising Lp(a) levels (aOR 1.023 per 25 nmol/L increase, 95% confidence interval 1.010-1.040, p = 0.0033). No effect modification was detected for menopausal status (p-value for interaction = 1.0), MHT use in postmenopausal women (p-value for interaction = 0.20), or OCP use in premenopausal women (p-value for interaction = 0.32).
Conclusion: Elevated Lp(a) is common and associated with prevalent CAD in Women Veterans. We did not detect modification of the association between elevated Lp(a) and prevalent CAD based on menopausal status or hormonal therapy. These findings support systematic Lp(a) screening across the full female reproductive spectrum.
Keywords
Lipoprotein(a), menopausal status, hormonal therapy, coronary artery disease
References
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© The Author(s) 2026. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
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Nallamshetty S, Cogill S, Heberer K, Maldonado AI, Seshadri A, Chen YQ, et al. Menopausal status, hormonal therapy, and elevated lipoprotein(a): Implications for prevalent coronary artery disease in U.S. Women Veterans. Adv Lipoprotein(a) Res. 2026;1:202610. https://doi.org/10.70401/alr.2026.0012
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Nallamshetty S, Cogill S, Heberer K, Maldonado AI, Seshadri A, Chen YQ, et al. Menopausal status, hormonal therapy, and elevated lipoprotein(a): Implications for prevalent coronary artery disease in U.S. Women Veterans. Adv Lipoprotein(a) Res. 2026;1:202610. https://doi.org/10.70401/alr.2026.0012
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