Epidemiology
Unlike LDL-C, Lp(a) is not associated with baseline coronary artery calcium and only modestly predicts its progression, in 5,597 MESA participants (J Clin Lipidol 2023)
Original title: Lipoprotein(a) and coronary artery calcium in comparison with other lipid biomarkers: The multi-ethnic study of atherosclerosis
In 5,597 participants without clinical atherosclerotic cardiovascular disease from the Multi-Ethnic Study of Atherosclerosis (MESA, excluding statin users; 2,726 with 9.5-year follow-up data), Lp(a) was not associated with baseline coronary artery calcium (CAC) volume or density and was only modestly associated with CAC volume progression (OR 1.11, 95% CI 1.03-1.21). In contrast, LDL-cholesterol was positively associated with both baseline CAC volume (OR 1.26, 95% CI 1.19-1.33) and its progression (OR 1.22, 95% CI 1.15-1.30), while HDL-cholesterol was inversely associated. In participants under 62 years, Lp(a) showed slightly stronger associations with baseline CAC volume (OR 1.10, 95% CI 1.00-1.20) and progression (OR 1.16, 95% CI 1.04-1.30). The findings suggest Lp(a), unlike other standard lipid biomarkers, is not robustly linked to coronary artery calcification, implying its cardiovascular risk may act through pathways other than calcification.
Original abstract
Background: Coronary artery calcium (CAC) scoring is often used for atherosclerotic cardiovascular disease (ASCVD) risk stratification in individuals with elevated lipoprotein(a) [Lp(a)].
Objective: To evaluate associations between Lp(a) and baseline CAC (volume/density) and CAC progression compared to other lipid biomarkers.
Methods: We utilized data from the Multi-Ethnic Study of Atherosclerosis (MESA), a cohort study of individuals without clinical ASCVD, excluding statin users. We evaluated the associations between Lp(a), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), triglycerides, total cholesterol, apolipoprotein B, and non-HDL-C with baseline CAC and annual CAC progression using multivariable ordinal regression with adjustment for ASCVD risk factors. Analyses were also stratified by median age.
Results: In 5,597 participants (2,726 at median 9.5-year follow-up), Lp(a) was not associated with baseline CAC volume or density and was modestly associated with volume progression (OR 1.11, 95% CI 1.03-1.21). However, other biomarkers were positively associated with baseline volume and volume progression (LDL-C: OR 1.26, 95% CI: 1.19-1.33 and OR 1.22, 95% CI: 1.15-1.30, respectively), except HDL-C which was inversely associated. LDL-C, total cholesterol and non-HDL-C were inversely associated with baseline density. In participants <62 years of age, Lp(a) was modestly associated with baseline CAC volume (OR 1.10, 95% CI: 1.00-1.20) and volume progression (OR 1.16 95% CI: 1.04-1.30).
Conclusions: In contrast to other lipid biomarkers, Lp(a) was not associated with baseline CAC volume or density and was only modestly associated with volume progression. Our findings suggest that Lp(a) is not as robustly associated with CAC as other lipid biomarkers.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.