The biologic function of Lp(a) in healthy adults is not fully understood, but the mechanisms by which elevated levels cause vascular disease may reflect their carriage of oxidized phospholipids47,48 or inhibition of plasminogen and promotion of thrombosis.49 The findings of this study highlight the role of Lp(a) for large-artery atherosclerosis, and suggest that Lp(a) may be relevant to peripheral arterial disease or heart failure that were not examined in this study. This evidence concerns the gene LPA and heart failure.