High Lp(a) accelerates low-attenuation (necrotic core) plaque progression on serial CT angiography (Kaiser et al., JACC 2022)

Original title: Association of Lipoprotein(a) With Atherosclerotic Plaque Progression

J Am Coll Cardiol · 25 January 2022 · 7

Kaiser Y, Daghem M, Tzolos E, Meah MN, Doris MK, Moss AJ, Kwiecinski J, Kroon J, Nurmohamed NS, van der Harst P, Adamson PD, Williams MC et al.

In 191 patients with advanced stable coronary disease imaged at baseline and 12 months (Amsterdam UMC and Edinburgh), those with Lp(a) of 70 mg/dL or more (median 100 mg/dL) had no more plaque at baseline but faster progression of low-attenuation plaque (26.2 vs -0.7 mm3), independent of risk score and plaque burden. A mechanism for the MI association: Lp(a) makes plaque more vulnerable, not just more abundant.

Original abstract

Background: Lipoprotein(a) [Lp(a)] is associated with increased risk of myocardial infarction, although the mechanism for this observation remains uncertain.

Objectives: This study aims to investigate whether Lp(a) is associated with adverse plaque progression.

Methods: Lp(a) was measured in patients with advanced stable coronary artery disease undergoing coronary computed tomography angiography at baseline and 12 months to assess progression of total, calcific, noncalcific, and low-attenuation plaque (necrotic core) in particular. High Lp(a) was defined as Lp(a) ≥ 70 mg/dL. The relationship of Lp(a) with plaque progression was assessed using linear regression analysis, adjusting for body mass index, segment involvement score, and ASSIGN score (a Scottish cardiovascular risk score comprised of age, sex, smoking, blood pressure, total and high-density lipoprotein [HDL]-cholesterol, diabetes, rheumatoid arthritis, and deprivation index).

Results: A total of 191 patients (65.9 ± 8.3 years of age; 152 [80%] male) were included in the analysis, with median Lp(a) values of 100 (range: 82 to 115) mg/dL and 10 (range: 5 to 24) mg/dL in the high and low Lp(a) groups, respectively. At baseline, there was no difference in coronary artery disease severity or plaque burden. Patients with high Lp(a) showed accelerated progression of low-attenuation plaque compared with low Lp(a) patients (26.2 ± 88.4 mm3 vs -0.7 ± 50.1 mm3; P = 0.020). Multivariable linear regression analysis confirmed the relation between Lp(a) and low-attenuation plaque volume progression (β = 10.5% increase for each 50 mg/dL Lp(a), 95% CI: 0.7%-20.3%). There was no difference in total, calcific, and noncalcific plaque volume progression.

Conclusions: Among patients with advanced stable coronary artery disease, Lp(a) is associated with accelerated progression of coronary low-attenuation plaque (necrotic core). This may explain the association between Lp(a) and the high residual risk of myocardial infarction, providing support for Lp(a) as a treatment target in atherosclerosis.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.