Background: Lipoprotein(a) [Lp(a)] has emerged as a genetically determined, independent risk factor for atherosclerotic cardiovascular disease (ASCVD), particularly in South Asians who often develop premature coronary artery disease (CAD). Despite growing evidence, Lp(a) remains underutilized in clinical risk stratification.

Objective: To assess the association between elevated serum Lp(a) levels and cardiovascular (CV) events and evaluate its diagnostic performance as a predictive marker.

Methods: This cross-sectional observational study included 50 adults aged 40–70 years attending a tertiary care hospital. Clinical history, risk factors, and Lp(a) levels were recorded. Patients were categorized based on history of CV events. Lp(a) was measured using immunoturbidimetric assay. Associations were analyzed using chi-square and t-tests, while ROC curve analysis assessed predictive value.

Results: Patients with CV events (n=17) had significantly higher mean Lp(a) levels than those without (41.3 ± 13.6 mg/dL vs. 24.5 ± 9.4 mg/dL; p< 0.001). Among patients with elevated Lp(a) (≥30 mg/dL), 60% had CV events, compared to 16.7% with normal Lp(a) (<30 mg/dL) (p = 0.004). The odds ratio for CV events in patients with elevated Lp(a) was 7.5 (95% CI: 1.96–28.5). ROC analysis showed good discriminative ability with an AUC of 0.84 (95% CI: 0.73–0.95; p< 0.001).

Conclusion: Elevated Lp(a) levels are strongly associated with cardiovascular events and demonstrate good predictive accuracy. These findings reinforce the clinical relevance of Lp(a) as an independent risk factor and support its inclusion in routine cardiovascular risk assessment.