This comprehensive meta-analysis evaluated the associations between elevated Lp(a) and the risk of premature ASCVD; the main findings are the followings: (i) elevated Lp(a) is significantly associated with higher risk of composite premature ASCVD, especially for CAD and PAD, and amongst patients with FH and T2DM, and (ii) the association between Lp(a) and premature ASCVD was significant regardless of study design, gender, population characteristics (community or hospitalized), different premature definitions, and various Lp(a) measurement approaches. This evidence concerns the gene LPA and peripheral arterial disease.