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Abstract : High lipoprotein(a) (Lp(a)) is consider as an independent risk factor for Acute vascular ischemic events (e.g.: Myocardial infarction (MI) and ischemic stroke). However, Prior data from other large, population-based cohort studies have been conflicting on coronary artery disease and ischemic stroke, with some studies linking elevated Lp(a) levels to a higher incidence of myocardial infarction and ischemic stroke whereas others have not found any association. Lp(a) had been measured for patients < 65 years of age presenting with myocardial infarction or ischemic stroke to cardiology and neurology departments in Mansoura University Hospitals, Dakahlia Governorate, Egypt, during the period from June 2020 to May 2022. Logistic regression model was used to determine the independent association of clinical characteristics with elevated Lp(a). A total of 103 patients were screened for Lp(a); 71.8 % males, mean age 50.7±7.9 years. Median Lp(a) levels were 26.3 mg/dl (interquartile range [IQR] 2-74). Elevated Lp(a) > 30 mg/dL was observed in 41.7% and associated with younger age with acute vascular ischemic events specially MI (48%). In a multiple logistic regression model, Family history of premature AVSE (MI & ischemic stroke) (odds ratio [OR] 3.36, 95% confidence interval [CI] 1.3-8.6, p = 0.01), younger age (< 45years) (p = 0.048) were independently associated with elevated Lp(a) in all cases of AVSE, in MI cases Family history of premature of CAD was more significant associated with high levels of Lp(a) (odds ratio [OR] 20.4, 95% confidence interval [CI] 2.3-174, p = 0.001), younger age (p=0.016). In contrast, Lp(a) levels were not associated with other traditional cardiovascular risk factors in all cases of MI as a subgroup. Young and middle aged patients < 65y years presented with acute vascular ischemic event (MI and stroke) were independently associated with elevated Lp(a), especially in patients with MI, young aged and with FH for premature acute vascular ischemic event.