Elevated Lp(a) tracks with lipid-rich, vulnerable coronary plaque specifically in diabetic patients on statins, the REASSURE-NIRS registry of 312 patients (Atherosclerosis 2022)

Original title: Elevated Lipoprotein(a) as a potential residual risk factor associated with lipid-rich coronary atheroma in patients with type 2 diabetes and coronary artery disease on statin treatment: Insights from the REASSURE-NIRS registry

Atherosclerosis · 10 April 2022 · 6

Nakamura H, Kataoka Y, Nicholls SJ, Puri R, Kitahara S, Murai K, Sawada K, Matama H, Iwai T, Honda S, Fujino M, Takagi K et al.

In the REASSURE-NIRS registry (NCT04864171), near-infrared spectroscopy imaging was used to measure maximum lipid-core burden index (maxLCBI4mm) in target coronary lesions of 312 statin-treated patients with coronary artery disease undergoing PCI. Lp(a) levels were significantly associated with maxLCBI4mm in patients with diabetes (P=0.01) but not in those without diabetes (P=0.96), while LDL-C predicted maxLCBI4mm only in patients without diabetes (P=0.03). Both LDL-C (P=0.01) and Lp(a) (P=0.04) were independent predictors of maxLCBI4mm in diabetic patients, and the Lp(a) association persisted even in diabetic patients who achieved LDL-C below 1.8 mmol/L (70 mg/dL, P=0.04). The findings suggest elevated Lp(a) may drive more vulnerable, lipid-rich coronary plaque specifically in patients with diabetes despite statin therapy and well-controlled LDL-C.

Original abstract

Background And Aims: The residual risk of atherosclerotic cardiovascular disease (ASCVD) in patients with diabetes on statin therapy warrants identification of other pro-atherogenic drivers. Lipoprotein(a) [Lp(a)] promotes the formation of necrotic cores within vessel walls. Given that patients with diabetes have an Lp(a)-associated ASCVD risk, Lp(a) might lead to plaque vulnerability in patients with diabetes on statin therapy.

Methods: We analyzed target lesions that underwent PCI in 312 patients with coronary artery disease (CAD) on statin treatment from the REASSURE-NIRS registry (NCT04864171). Maximum 4-mm lipid-core-burden index (maxLCBI4mm) in target lesions was measured with near-infrared spectroscopy (NIRS) imaging. The relationship between Lp(a) levels and maxLCBI4mm was investigated in patients with and without diabetes.

Results: High-intensity statin use (p = 0.49) and on-treatment low-density lipoprotein cholesterol (LDL-C) (p = 0.32) and Lp(a) levels (p = 0.09) were comparable between patients with and without diabetes. Lp(a) levels were significantly associated with maxLCBI4mm in patients with diabetes (p = 0.01) but not in patients without diabetes (p = 0.96). Multivariate analysis showed that LDL-C levels (p = 0.03) predict maxLCBI4mm in patients without diabetes, but not Lp(a) levels (p = 0.91). Both LDL-C (p = 0.01) and Lp(a) (p = 0.04) levels were independent predictors of maxLCBI4mm in patients with diabetes. Even in patients with diabetes achieving LDL-C <1.8 mmol/L (70 mg/dL), Lp(a) levels remained associated with maxLCBI4mm (p = 0.04).

Conclusions: A significant relationship between Lp(a) and maxLCBI4mm exists in patients with diabetes and CAD on statin treatment, even with LDL-C <1.8 mmol/L (70 mg/dL). Lp(a) might be associated with more vulnerable coronary atheroma in patients with diabetes despite receiving statin therapy.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.