Physicians' Academy for Cardiovascular Education

Elevated Lp(a) associated with adverse plaque progression in ASCVD

Association of Lipoprotein(a) With Atherosclerotic Plaque Progression

Literature - Kaiser Y, Daghem M, Tzolos E et al. - J Am Coll Cardiol. 2022 Jan 25;79(3):223-233. doi: 10.1016/j.jacc.2021.10.044.

Introduction and methods


Lp(a) is associated with an increased risk of ASCVD, even in patients on intensive lipid-lowering therapy [1]. However, the underlying mechanisms of the relationship between elevated Lp(a) and residual CV risk remain unclear.

Aim of the study

This study investigated whether elevated Lp(a) is associated with adverse plaque progression in patients with ASCVD on guideline-directed preventive therapies.


191 patients aged ≥40 years and proven multivessel CAD (≥ 2 major epicardial vessels with >50% luminal stenosis or previous PCI or CABG) were included in this study. Patients with coronary revascularization within the previous 3 months or ACS within the previous 12 months were excluded.

Patients underwent coronary computed tomography angiography (CCTA) at baseline and at 12 months. The same imaging protocol and the same scanner were used for repeat CCTA. Coronary atherosclerotic plaque volumes were measured for total plaque, calcific plaque, noncalcific plaque, fibro-fatty plaque, and low-attenuation plaque (a marker of necrotic core). Plaque progression was defined as the difference in plaque volumes between the two scans.

The effect of high Lp(a) (≥70 mg/dL) vs. low Lp(a) (<70 mg/dL) on change in plaque volume from baseline to follow-up CCTA was analyzed. In addition, the percentage change in plaque volume, standardized for each 50 mg/dL increase in Lp(a) was assessed in univariable and multivariable linear regression analyses.

Main results

Baseline characteristics

Plaque progression in those with Lp(a) ≥70 mg/dL vs. Lp(a) <70 mg/dL

Percentage change in plaque volume for each 50 mg/dL increase in Lp(a)


This study shows that elevated Lp(a) is independently associated with accelerated progression of low-attenuation plaque in patients with advanced multivessel CAD on guideline-directed preventive therapies.


Show references

Find this article online at J Am Coll Cardiol.

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