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Association of Lipoprotein(a) With Atherosclerotic Plaque Progression

Yannick Kaiser1, Marwa Daghem2, Evangelos Tzolos2

  • 1Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.

Journal of the American College of Cardiology
|January 21, 2022
PubMed

Insights

High lipoprotein(a) levels are linked to faster progression of dangerous low-attenuation plaque in coronary arteries. This finding may explain the increased heart attack risk associated with lipoprotein(a) and suggests it as a treatment target.

Area of Science:

  • Cardiovascular Medicine
  • Biochemistry
  • Medical Imaging

Background:

  • Lipoprotein(a) [Lp(a)] is a known risk factor for myocardial infarction.
  • The precise mechanism linking Lp(a) to cardiovascular events remains unclear.
  • Understanding Lp(a)'s role in atherosclerosis progression is crucial for risk stratification.

Purpose of the Study:

  • To investigate the association between Lp(a) levels and the progression of coronary artery plaque.
  • To specifically examine the impact of Lp(a) on different plaque components, including low-attenuation plaque (necrotic core).

Main Methods:

  • Lp(a) levels were measured in patients with advanced stable coronary artery disease.
  • Coronary computed tomography angiography was used for baseline and 12-month plaque assessment.
  • Linear regression analysis was employed to evaluate the relationship between Lp(a) and plaque progression, with adjustments for relevant covariates.

Main Results:

  • Patients with high Lp(a) (≥ 70 mg/dL) exhibited accelerated progression of low-attenuation plaque compared to those with low Lp(a).
  • Multivariable analysis confirmed a significant association between higher Lp(a) levels and increased low-attenuation plaque volume.
  • No significant differences in the progression of total, calcific, or noncalcific plaque were observed between high and low Lp(a) groups.

Conclusions:

  • Elevated Lp(a) is associated with accelerated progression of coronary low-attenuation plaque, a marker of vulnerable plaque.
  • This finding provides a potential mechanism for the observed association between Lp(a) and myocardial infarction risk.
  • Lp(a) emerges as a potential therapeutic target for managing atherosclerosis and reducing residual cardiovascular risk.
Abstract

Keywords:
coronary computed tomography angiographylipoprotein(a)low-attenuation plaque

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