Related Experiment Video
Updated: Aug 6, 2026
Cell-free Biochemical Fluorometric Enzymatic Assay for High-throughput Measurement of Lipid Peroxidation in High Density Lipoprotein
Published on: October 12, 2017
Association of Lipoprotein(a) With Coronary Atherosclerosis and Cardiovascular Events: Findings From the SCAPIS
Elias Björnson1, Göran Bergström2, Jonas Brinck3
1Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Insights
High lipoprotein(a) (Lp[a]) significantly increases coronary heart disease risk by driving greater atherosclerosis. This elevated risk is largely explained by increased plaque burden, not plaque vulnerability.
Area of Science:
- Cardiology
- Genetics
- Epidemiology
Background:
- High lipoprotein(a) (Lp[a]) is linked to increased coronary heart disease (CHD) risk.
- The mechanism by which Lp[a] elevates CHD risk, specifically the role of coronary plaque burden, requires further clarification.
Purpose of the Study:
- To investigate if elevated cardiovascular risk associated with Lp[a] is primarily due to increased coronary atherosclerosis.
- To determine if plaque vulnerability plays a significant role independent of plaque burden.
Main Methods:
- Analysis of 28,529 individuals from the Swedish CArdioPulmonary bioImage Study (SCAPIS).
- Coronary computed tomography angiography used to assess coronary atherosclerosis in 25,916 participants.
- Ascertainment of incident coronary events over a median follow-up of 7.8 years.
Main Results:
- High Lp(a) (14% of participants) correlated with severe/extensive coronary atherosclerosis and increased coronary events.
- Mediation analyses indicated that greater atherosclerotic burden largely explains the Lp[a]-coronary event risk association (P < 0.0001).
- Individuals with high Lp(a) developed atherosclerosis 2-3 years earlier; Lp(a) accounted for 5-10% of severe atherosclerosis and ~7% of coronary events.
Conclusions:
- Lp(a) elevates coronary event risk predominantly by increasing the burden of coronary atherosclerosis.
- High Lp(a) contributes significantly to the overall population burden of coronary disease.
- Supports routine Lp[a] measurement and coronary imaging for risk stratification in high Lp[a] individuals.
Background:
High lipoprotein(a) (Lp[a]) associates with elevated coronary heart disease event risk, but it remains uncertain whether this excess risk can be explained by increased coronary plaque burden.
Objectives:
This study aims to determine whether Lp(a)-related excess cardiovascular risk in the general population is primarily explained by increased coronary atherosclerosis or by additional plaque vulnerability-related effects.
Methods:
This study included 28,529 middle-aged individuals from the SCAPIS (Swedish CArdioPulmonary bioImage Study), a population-based cohort. Coronary atherosclerosis was assessed using coronary computed tomography angiography in 25,916 participants. Incident coronary events, defined as fatal or nonfatal myocardial infarction, were ascertained over a median follow-up of 7.8 years.
Results:
High Lp(a) was present in 14% of participants and associated with severe/extensive coronary atherosclerosis (Segment Involvement Score >4; OR: 1.38; 95% CI: 1.21-1.57) and coronary events (HR: 1.54; 95% CI: 1.18-2.0). Stratified, adjusted, and mediation analyses consistently suggested that the association between Lp(a) and coronary event risk is largely explained by greater atherosclerotic burden (P for mediation <0.0001). Individuals with high Lp(a) developed atherosclerosis 2 to 3 years earlier and the population-attributable fraction of Lp(a) was 5% to 10% for severe atherosclerosis and around 7% for coronary events.
Conclusion:
The findings suggest that Lp(a) increases coronary event risk primarily by driving a higher burden of atherosclerosis and that high Lp(a) accounts for 5% to 10% of total coronary disease burden in the population. These results support broad Lp(a) measurements and the use of coronary imaging for risk stratification in individuals with high Lp(a).
Related Concept Videos
01:26Atherosclerosis III: Management
01:30Coronary Artery Disease I: Introduction
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:26Coronary Artery Disease IV: Preventive Measures
01:25Blood Studies for Cardiovascular System III: Serum Lipid Profile
Serum lipids are fats and fatty substances in the blood and are crucial for various bodily functions, including energy storage, cellular structure, and hormone production. Serum lipids consist of cholesterol, triglycerides, and phospholipids.
Cholesterol is a soft, fat-like substance found in all body cells. It is crucial for producing hormones, vitamin D, and substances that aid...
01:27Atherosclerosis II: Clinical Manifestations and Diagnostic Tests