In subgroup analysis according to study design, elevated Lp(a) was associated with significantly increased risk of premature ASCVD in cross-sectional studies (OR: 2.09, 95% CI: 1.59–2.75, P < 0.001), retrospective studies (OR: 2.84, 95% CI: 2.31–3.50, P < 0.001), and prospective studies (OR: 1.73, 95% CI: 1.40–2.13, P < 0.001) (see Supplementary material online, Figure S3). Here, LPA is linked to atherosclerosis.