Epidemiology
Elevated Lp(a) raises coronary artery calcification risk by 58% in asymptomatic adults, a meta-analysis of 12 studies (Nutr Metab Cardiovasc Dis 2023)
Original title: Predictive value of lipoprotein(a) in coronary artery calcification among asymptomatic cardiovascular disease subjects: A systematic review and meta-analysis
This systematic review and meta-analysis (PROSPERO CRD42022350297) pooled 8 cross-sectional studies (18,668 participants) and 4 cohort studies (15,355 participants) examining the association between Lp(a) and coronary artery calcification (CAC) in people without cardiovascular symptoms. Cohort studies showed elevated Lp(a) (cut-offs of 30-50 mg/dL) was significantly associated with CAC incidence (OR 1.58, 95% CI 1.38-1.80, I2 0.0%). Subgroup analysis found race, but not the specific Lp(a) cut-off used, significantly affected the association (OR 1.60, 95% CI 1.41-1.81), and the CAC risk from higher Lp(a) was similar in men and women. The findings support Lp(a) as a useful biomarker for identifying subclinical atherosclerosis in asymptomatic individuals at risk of coronary calcification.
Original abstract
Aims: Studies have indicated inconsistent results regarding the association between plasma levels of Lipoprotein(a) [Lp(a)] and coronary artery calcification (CAC). We performed a systematic review and meta-analysis to investigate the association between elevated levels of Lp(a) and risk of CAC in populations free of cardiovascular disease (CVD) symptoms.
Data Synthesis: PubMed, Web of Science, Embase, and Scopus were searched up to July 2022 and the methodological quality was assessed using Newcastle-Ottawa Scale (NOS) scale. Random-effects meta-analysis was used to estimate pooled odds ratio (OR) and 95% confidence interval. Out of 298 studies, data from 8 cross-sectional (n = 18,668) and 4 cohort (n = 15,355) studies were used in meta-analysis. Cohort studies demonstrated a positive significant association between Lp(a) and CAC, so that individuals with Lp(a)≥30-50 exposed to about 60% risk of CAC incidence compared to those with lower Lp(a) concentrations in asymptomatic CVD subjects (OR, 1.58; 95% CI, 1.38-1.80; l2, 0.0%; P, 0.483); Subgroup analysis showed that a cut-off level for Lp(a) measurement could not statistically affect the association, but race significantly affected the relationship between Lp(a) and CAC (OR,1.60; 95% CI, 1.41-1.81). Analyses also revealed that both men and women with higher Lp(a) concentrations are at the same risk for increased CAC.
Conclusions: Blood Lp(a) level was significantly associated with CAC incidence in asymptomatic populations with CVD, indicating that measuring Lp(a) may be a useful biomarker for diagnosing subclinical atherosclerosis in individuals at higher risk of CAC score.
Prospero Registration Number: CRD42022350297.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.