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Use of Coronary Artery Calcium Scoring in Individuals With Elevated Lipoprotein(a): A Multicohort Study

Harpreet S Bhatia1, Yihang Fan2, Gourisree Dharmavaram1

  • 1Division of Cardiovascular Medicine, University of California-San Diego, La Jolla, California, USA.

Journal of the American College of Cardiology
|March 16, 2026
PubMed

Insights

Elevated lipoprotein(a) [Lp(a)] increases atherosclerotic cardiovascular disease (ASCVD) risk across all coronary artery calcium (CAC) scores. Even with CAC of 0, CAC scoring remains crucial for assessing ASCVD risk in individuals with elevated Lp(a).

Area of Science:

  • Cardiology
  • Preventive Medicine
  • Biomarkers

Background:

  • Lipoprotein(a) [Lp(a)] is linked to atherosclerotic cardiovascular disease (ASCVD) but its interaction with coronary artery calcium (CAC) scoring for risk assessment is unclear.
  • Lp(a) is known to promote noncalcified plaque, potentially limiting the utility of CAC scoring.

Purpose of the Study:

  • To evaluate the interaction between elevated Lp(a) (>50 mg/dL) and CAC score.
  • To assess the association of Lp(a) with ASCVD risk across different CAC strata.

Main Methods:

  • Pooled analysis of 4 prospective U.S. cohort studies including 11,319 participants without known ASCVD.
  • Multivariable Cox regression models were used to evaluate the association between elevated Lp(a) and incident ASCVD across CAC strata.

Main Results:

  • Elevated Lp(a) and CAC >0 were independently associated with increased ASCVD risk.
  • Individuals with CAC = 0 had low ASCVD rates, but higher risk if Lp(a) was elevated (HR: 1.28).
  • The highest ASCVD risk was observed in individuals with both CAC ≥300 and elevated Lp(a) (HR: 6.12).

Conclusions:

  • Elevated Lp(a) is associated with increased relative ASCVD risk across all CAC score levels, including CAC of 0.
  • Despite elevated Lp(a), absolute ASCVD event rates remain low in individuals with CAC of 0.
  • CAC scoring is a valuable tool for ASCVD risk assessment, even in the presence of elevated Lp(a).
Abstract

Keywords:
coronary artery calciumlipidslipoprotein(a)preventionrisk factors

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