Lipoprotein(a) and Coronary Plaque in Asymptomatic Adults

Elevated Lp(a) was associated with a greater likelihood of coronary plaque.

After adjustment for other factors, participants with Lp(a) ≥125 nmol/L had 40% higher odds of having coronary plaque compared with participants with lower Lp(a).

The researchers also found an association between elevated Lp(a) and the presence of two or more high-risk plaque features. The adjusted odds were almost four times higher.

However, this finding requires caution. Only 35 participants in the entire study had two or more high-risk plaque features. The authors therefore emphasized that larger studies are needed to confirm this association.

An important finding emerged among the 1 200 participants with no detectable coronary calcium.

In this group, coronary plaque was found in 24.2% of participants with elevated Lp(a) compared with 14.2% of those with lower Lp(a).

Lp(a) is an established cardiovascular risk factor. This study provides additional information about how elevated Lp(a) may relate to atherosclerosis already present in the coronary arteries.

The association was observed in adults who had no cardiovascular symptoms and no known atherosclerotic cardiovascular disease.

The findings are particularly relevant when coronary calcium is absent.

A calcium score of zero is generally reassuring. However, in this study it did not mean that coronary plaque was necessarily absent. Among participants with no detectable coronary calcium, plaque was more common when Lp(a) was elevated.

This demonstrates why different cardiovascular markers can provide complementary information.

Lp(a) identifies an important component of cardiovascular risk. Coronary calcium reflects calcified atherosclerotic burden. Detailed coronary imaging can directly identify plaque, including disease that may not yet be calcified.

Elevated Lp(a) should not be interpreted in isolation. Its clinical significance depends on the broader cardiovascular risk profile.

This study nevertheless provides an important observation. Elevated Lp(a) was independently associated with coronary plaque even after adjustment for other factors.

The findings among participants with no coronary calcium are also clinically relevant. A calcium score of zero did not completely exclude coronary atherosclerosis, particularly in people with elevated Lp(a).

In selected patients with elevated Lp(a) and additional cardiovascular risk factors, coronary imaging may therefore provide information that cannot be obtained from Lp(a), conventional risk factors or coronary calcium alone.

Coronary CT angiography can directly assess the presence and extent of coronary plaque and identify coronary artery narrowing. In appropriately selected patients, these findings may influence the intensity of preventive treatment or indicate the need for further cardiovascular assessment.

The study was observational and based on cross-sectional imaging. It cannot demonstrate that elevated Lp(a) caused the observed plaque or that performing CCTA improves cardiovascular outcomes.

The association with multiple high-risk plaque features is potentially important but should also be interpreted cautiously because relatively few participants had this finding. The authors specifically call for larger studies to confirm it.