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Sex-Specific Prognostic Differences Between CACS and Lp(a) in Atherosclerotic Cardiovascular Disease Events: The MESA

Ruijia Xue1, Jiali Liu2,3, Haoyang Wang4

  • 1Department of Radiology, The Affiliated Xi'an Central Hospital of Xi'an Jiaotong University, Xi'an, China (R.X., X.W., M.M.).

Circulation. Cardiovascular Imaging
|November 6, 2025
PubMed

Insights

Lipoprotein(a) and coronary artery calcium score independently predict cardiovascular risk. Their predictive value differs between sexes, especially in specific coronary artery calcium score categories, informing sex-specific prevention strategies.

Area of Science:

  • Cardiology
  • Preventive Medicine
  • Biomarkers

Background:

  • Lipoprotein(a) [Lp(a)] and coronary artery calcium score (CACS) are established independent predictors of atherosclerotic cardiovascular disease (ASCVD) risk.
  • Understanding potential sex-specific differences in the prognostic value of Lp(a) and CACS is crucial for refining ASCVD risk assessment.

Purpose of the Study:

  • To investigate sex-specific prognostic differences between Lp(a) and CACS in predicting ASCVD risk.
  • To compare the predictive performance of Lp(a) and CACS in men and women.

Main Methods:

  • Analysis of 4651 participants from the Multi-Ethnic Study of Atherosclerosis, stratified by sex.
  • Multivariable Cox regression analysis to evaluate the prognostic value of Lp(a) and CACS for ASCVD risk.
  • Comparison of predictive performance using C-index analysis.

Main Results:

  • Both elevated Lp(a) and CACS were independent predictors of ASCVD risk in both sexes over a median follow-up of 13.84 years.
  • CACS provided incremental prognostic value over Lp(a) in men (P=0.011) but not in women (P=0.069).
  • Elevated Lp(a) was associated with higher ASCVD risk in men with CACS >400 and in women with CACS >100.

Conclusions:

  • While Lp(a) and CACS independently predict ASCVD risk, Lp(a)'s predictive value varies significantly between sexes across different CACS categories.
  • Findings suggest the need for sex-specific strategies in the primary prevention of ASCVD, considering both Lp(a) and CACS levels.
Abstract

Keywords:
atherosclerosiscalciumcardiovascular diseaseprimary preventionregression analysis

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