Meta-analysis of 23,105 asymptomatic patients finds elevated Lp(a) raises the odds of any coronary calcium by 31%, though evidence certainty is low (Eur J Prev Cardiol 2024)

Original title: The association of lipoprotein(a) and coronary artery calcium in asymptomatic patients: a systematic review and meta-analysis

Eur J Prev Cardiol · 18 April 2024 · 6

Martignoni FV, Rl Júnior JE, Marques IR, Gomes C, Moreira VCS, de Souza IAF, Miyawaki IA, Silva CH, do Amaral Neto AB, Padrão EMH, Cardoso R, de Vasconcellos HD et al.

This PROSPERO-registered systematic review and meta-analysis searched PubMed, Embase and Cochrane through April 2023 for studies examining Lp(a) and coronary artery calcium (CAC) in asymptomatic patients, pooling 18 studies covering 23,105 patients (mean age 55.9 years, 46.4% female). Elevated Lp(a) was associated with higher odds of CAC above zero Agatston units (odds ratio 1.31, 95% CI 1.05-1.64, P = 0.02), CAC at or above 100 (odds ratio 1.29, 95% CI 1.01-1.65, P = 0.04), and CAC progression over time (odds ratio 1.43, 95% CI 1.20-1.70, P < 0.01). Each 1 mg/dL increment in Lp(a) was associated with a 1% higher odds of CAC above zero (odds ratio 1.01, 95% CI 1.01-1.01, P < 0.01). The authors conclude Lp(a) is positively associated with coronary calcification in asymptomatic individuals, consistent with its atherogenic role, though they caution the evidence carries high heterogeneity and low overall certainty.

Original abstract

Aims: Lipoprotein(a) [Lp(a)] is an atherogenic lipid particle associated with increased risk for coronary heart disease (CHD) events. Coronary artery calcium (CAC) score is a tool to diagnose subclinical atherosclerosis and guide clinical decision-making for primary prevention of CHD. Studies show conflicting results concerning the relationship between Lp(a) and CAC in asymptomatic populations. We conducted a meta-analysis to evaluate the association of Lp(a) and CAC in asymptomatic patients.

Methods And Results: We systematically searched PubMed, Embase, and Cochrane until April 2023 for studies evaluating the association between Lp(a) and CAC in asymptomatic patients. We evaluated CAC > 0 Agatston units, and CAC ≥ 100. Lp(a) was analysed as a continuous or dichotomous variable. We assessed the association between Lp(a) and CAC with pooled odds ratios (OR) adopting a random-effects model. A total of 23 105 patients from 18 studies were included in the meta-analysis with a mean age of 55.9 years, 46.4% female. Elevated Lp(a) increased the odds of CAC > 0 [OR 1.31; 95% confidence intervals (CI) 1.05-1.64; P = 0.02], CAC ≥100 (OR 1.29; 95% CI 1.01-1.65; P = 0.04; ), and CAC progression (OR 1.43; 95% CI 1.20-1.70; P < 0.01; ). For each increment of 1 mg/dL in Lp(a) there was a 1% in the odds of CAC > 0 (OR 1.01; 95% CI 1.01-1.01; P < 0.01).

Conclusion: Our findings of this meta-analysis suggest that Lp(a) is positively associated with a higher likelihood of CAC. Higher Lp(a) levels increased the odds of CAC >0. These data support the concept that Lp(a) is atherogenic, although with high heterogeneity and a low level of certainty.

Protocol Registration: CRD42023422034.

Key Findings: Asymptomatic patients with elevated Lp(a) had 31% higher chances of having any coronary calcification (CAC > 0) and 29% higher chances of having more advanced calcification (CAC > 100). It increased the chances of having progression of coronary calcification over time by 43%. For each 1 mg/dL of Lp(a) there was an increment of 1% chance of having coronary calcification.

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