Elevated Lp(a) is associated with both the prevalence and progression of coronary artery calcification, a meta-analysis of 40,073 individuals (Atherosclerosis 2024)

Original title: The association of lipoprotein (a) with coronary artery calcification: A systematic review and meta-analysis

Atherosclerosis · 3 December 2023 · 7

Qiu Y, Hao W, Guo Y, Guo Q, Zhang Y, Liu X, Wang X, Nie S

This systematic review and meta-analysis of 17 studies (40,073 individuals) examined the association between Lp(a) and coronary artery calcification (CAC, Agatston score) up to November 2023. Elevated Lp(a) (cut-offs of 30-50 mg/dL or the highest quartile, 33-38.64 mg/dL, across studies) was associated with higher CAC prevalence (OR 1.31, 95% CI 1.06-1.61, P=0.01), and Lp(a) as a continuous variable correlated with CAC prevalence (OR 1.05, 95% CI 1.02-1.08, P=0.003). Elevated Lp(a) was also associated with greater CAC progression (OR 1.54, 95% CI 1.23-1.92, P=0.0002). The consistent dose-response relationship strengthens the case for Lp(a) as a driver of vascular calcification, though whether Lp(a)-lowering therapy can prevent CAC progression remains untested.

Original abstract

Background And Aims: Coronary artery calcification (CAC) is a crucial pathophysiological characteristic of atherosclerosis. The association between lipoprotein (a) [Lp(a)] and CAC is inconsistent. We aimed to assess the relationship between Lp(a) and CAC by exploring the association between elevated Lp(a) and CAC prevalence, the relationship between Lp(a) level and CAC prevalence, and the correlation between elevated Lp(a) and CAC progression.

Methods: We searched the PubMed, Web of Science, and EMBASE databases up to November 01, 2023. Studies exploring the association between serum Lp(a) and CAC (quantified using the Agatston score) were included. Association between Lp(a) level or elevated Lp(a) (higher than the cutoff values of 30 mg/dL, 50 mg/dL, or the highest quartile ranging from 33 to 38.64 mg/dL) and prevalence [CAC score >0 or >100, log (CAC score+1) >0] or progression (an increase in CAC score >0 or ≥100) of CAC were analysed. Odds ratios and 95% confidence intervals were calculated using a random-effects model.

Results: 40,073 individuals from 17 studies were included. Elevated Lp(a) was associated with a higher prevalence of CAC (OR, 1.31; 95% CI, 1.06 to 1.61; p = 0.01). As a continuous variable, Lp(a) level was positively correlated with the prevalence of CAC (OR, 1.05; 95% CI, 1.02 to 1.08; p = 0.003). Furthermore, elevated Lp(a) was associated with greater CAC progression (OR, 1.54; 95% CI, 1.23 to 1.92; p = 0.0002).

Conclusions: This meta-analysis suggested that Lp(a) is associated with prevalence and progression of CAC. Further studies are required to explore whether Lp(a)-lowering therapy could prevent or inhibit CAC, ultimately reducing coronary artery disease risk.

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