Purpose: Elevated lipoprotein(a), Lpa, has quickly emerged as an independent cardiovascular disease risk factor with increased risk for adverse atherosclerotic Using the National Inpatient Sample (NIS) database, we sought to assess the association of elevated Lp(a) to in-hospital cardiovascular outcomes. Methods: We identified patients with elevated Lpa using ICD-10 code in the NIS data from the year 2019. We compared in-hospital outcomes between elevated and non-elevated Lpa groups before and after propensity score matching. We then performed a regression analysis on the matched cohort. Our predictors of interest were acute myocardial infarction (AMI), cerebrovascular disease (CEVD), peripheral vascular disease (PVD), and a composite outcome (cardiorisk) including, AMI, CEVD, and PVD. Results: In the unmatched cohort, the elevated Lpa group had higher incidences of AMI, CEVD, PVD, and the composite outcome (all p<0.05). However, length of stay and cost of hospitalization did not differ considerably. After propensity score matching, the elevated Lpa group had higher rates of AMI (7.1% vs 1.2%, p<0.001), CEVD (11.2% vs 2.8%, p<0.001), PVD (1.8% vs 0.2%, p=0.021), and composite outcome (20% vs 6%, p<0.01). Elevated Lpa group had longer length of stay 5±5 vs 4±3, p=0.002), and higher cost of hospitalization (69,060 ± 76,028 vs 20,992±15,065, p<0.001). Multivariable regression analysis controlling for common predictors of atheroembolic risk showed higher odds of AMI (2.33, p<0.001), CEVD (1.62, p= 0.002), PVD (2.22, p=0.094), and cardiorisk (1.68, p<0.001) among the elevated Lpa group. Conclusion: Elevated Lpa is associated with a higher incidence of atheroembolic disease in this nationally representative sample and associated with a higher length of stay and healthcare costs. Further research is needed to fully understand its mechanism and possible treatment to reduce adverse cardiovascular outcomes.