Lp(a) and its oxidised phospholipids predict multivessel coronary disease and cardiovascular events in 1,098 patients undergoing angiography, the CASABLANCA study (J Am Coll Cardiol 2023)

Original title: Lipoprotein(a), Oxidized Phospholipids, and Coronary Artery Disease Severity and Outcomes

J Am Coll Cardiol · 9 May 2023 · 7

Gilliland TC, Liu Y, Mohebi R, Miksenas H, Haidermota S, Wong M, Hu X, Cristino JR, Browne A, Plutzky J, Tsimikas S, Januzzi JL et al.

Among 1,098 participants referred for coronary angiography in the CASABLANCA study, median Lp(a) was 26.45 nmol/L (IQR 11.39-89.49), and Lp(a), oxidised-phospholipid-apoB (OxPL-apoB), and oxidised-phospholipid-apo(a) (OxPL-apo(a)) were all highly correlated (Spearman R>=0.91). Per doubling, Lp(a) and OxPL-apoB were significantly associated with multivessel coronary disease (odds ratio 1.10, 95% CI 1.03-1.18, P=0.006; and OR 1.18, 95% CI 1.03-1.34, P=0.01, respectively). All three biomarkers predicted major adverse cardiovascular events during follow-up, with hazard ratios per doubling of 1.08 (95% CI 1.03-1.14, P=0.001) for Lp(a), 1.15 (95% CI 1.05-1.26, P=0.004) for OxPL-apoB, and 1.07 (95% CI 1.01-1.14, P=0.02) for OxPL-apo(a). The findings support Lp(a) and its oxidised phospholipid cargo as complementary markers of coronary disease severity and future cardiovascular risk even in statin-treated patients.

Original abstract

Background: Lipoprotein(a) (Lp[a]) and oxidized phospholipids (OxPLs) are each independent risk factors for atherosclerotic cardiovascular disease. The extent to which Lp(a) and OxPLs predict coronary artery disease (CAD) severity and outcomes in a contemporary, statin-treated cohort is not well established.

Objectives: This study sought to evaluate the relationships between Lp(a) particle concentration and OxPLs associated with apolipoprotein B (OxPL-apoB) or apolipoprotein(a) (OxPL-apo[a]) with angiographic CAD and cardiovascular outcomes.

Methods: Among 1,098 participants referred for coronary angiography in the CASABLANCA (Catheter Sampled Blood Archive in Cardiovascular Diseases) study, Lp(a), OxPL-apoB, and OxPL-apo(a) were measured. Logistic regression estimated the risk of multivessel coronary stenoses by Lp(a)-related biomarker level. Cox proportional hazards regression estimated the risk of major adverse cardiovascular events (MACEs) (coronary revascularization, nonfatal myocardial infarction, nonfatal stroke, and cardiovascular death) in follow-up.

Results: Median Lp(a) was 26.45 nmol/L (IQR: 11.39-89.49 nmol/L). Lp(a), OxPL-apoB, and OxPL-apo(a) were highly correlated (Spearman R ≥0.91 for all pairwise combinations). Lp(a) and OxPL-apoB were associated with multivessel CAD. Odds of multivessel CAD per doubling of Lp(a), OxPL-apoB, and OxPL-apo(a) were 1.10 (95% CI: 1.03-1.18; P = 0.006), 1.18 (95% CI: 1.03-1.34; P = 0.01), and 1.07 (95% CI: 0.99-1.16; P = 0.07), respectively. All biomarkers were associated with cardiovascular events. HRs for MACE per doubling of Lp(a), OxPL-apoB, and OxPL-apo(a) were 1.08 (95% CI: 1.03-1.14; P = 0.001), 1.15 (95% CI: 1.05-1.26; P = 0.004), and 1.07 (95% CI: 1.01-1.14; P = 0.02), respectively.

Conclusions: In patients undergoing coronary angiography, Lp(a) and OxPL-apoB are associated with multivessel CAD. Lp(a), OxPL-apoB, and OxPL-apo(a) are associated with incident cardiovascular events. (Catheter Sampled Blood Archive in Cardiovascular Diseases [CASABLANCA]; NCT00842868).

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