The Evolving Role of Coronary Artery Imaging in Assessing Cardiovascular Risk from Lipoprotein(a)

Summarize current literature on the use of coronary artery imaging modalities in examining the atherosclerotic and arterial inflammatory manifestations of elevated lipoprotein(a) [Lp(a)]. Evaluate the evolving role of coronary imaging in risk stratification and treatment decisions.

While Lp(a) and calcium scoring (CAC) are independently associated with cardiovascular risk, Lp(a) is associated with CAC incidence and progression. Lp(a) is associated with greater plaque prevalence, multivessel disease, and high-risk morphologies, while also being linked to accelerated progression of mixed and lipid-rich plaque by coronary CT angiography. Intravascular imaging modalities further show associations between Lp(a) and thin-cap fibroatheroma, lipid-rich plaque, percent atheroma volume, and plaque progression. Lp(a) is associated with non-calcified or mixed coronary plaque morphology and progression, as well as increased risk of high-risk plaque features. While additional research is needed, current literature suggests that coronary imaging may be an important tool in cardiovascular risk stratification for individuals with elevated Lp(a).