Mechanisms
Lp(a) alone, without added oxidized phospholipid measures, doubles the odds of a major limb event in 446 angiography patients (J Lipid Res 2024)
Original title: Associations between lipoprotein(a), oxidized phospholipids, and extracoronary vascular disease
In 446 participants who underwent coronary and/or peripheral angiography and were followed for a median 3.7 years, the authors compared Lp(a) with oxidized phospholipids on apolipoprotein B (OxPL-apoB) and apolipoprotein(a) (OxPL-apo(a)) as predictors of extracoronary vascular disease and major adverse limb events (MALEs). Elevated Lp(a) (150 nmol/L or above) had a stronger association with extracoronary vascular disease than either OxPL measure, and adding OxPLs to the model improved it only minimally. Compared with participants with normal Lp(a) and OxPL levels, those with elevated Lp(a) were twice as likely to experience a MALE (odds ratio 2.14, 95% CI 1.03-4.44), and this association, along with a model C-statistic of 0.82, was largely unchanged by adding OxPL-apoB and OxPL-apo(a). While elevated Lp(a) and OxPLs both contribute to extracoronary vascular disease progression and complications, Lp(a) alone captures essentially the same risk information as the combined panel, simplifying risk assessment for peripheral atherosclerosis.
Original abstract
The roles of lipoprotein(a) [Lp(a)] and related oxidized phospholipids (OxPLs) in the development and progression of coronary disease is known, but their influence on extracoronary vascular disease is not well-established. We sought to evaluate associations between Lp(a), OxPL apolipoprotein B (OxPL-apoB), and apolipoprotein(a) (OxPL-apo(a)) with angiographic extracoronary vascular disease and incident major adverse limb events (MALEs). Four hundred forty-six participants who underwent coronary and/or peripheral angiography were followed up for a median of 3.7 years. Lp(a) and OxPLs were measured before angiography. Elevated Lp(a) was defined as ≥150 nmol/L. Elevated OxPL-apoB and OxPL-apo(a) were defined as greater than or equal to the 75th percentile (OxPL-apoB ≥8.2 nmol/L and OxPL-apo(a) ≥35.8 nmol/L, respectively). Elevated Lp(a) had a stronger association with the presence of extracoronary vascular disease compared to OxPLs and was minimally improved with the addition of OxPLs in multivariable models. Compared to participants with normal Lp(a) and OxPL concentrations, participants with elevated Lp(a) levels were twice as likely to experience a MALE (odds ratio: 2.14, 95% confidence interval: 1.03, 4.44), and the strength of the association as well as the C statistic of 0.82 was largely unchanged with the addition of OxPL-apoB and OxPL-apo(a). Elevated Lp(a) and OxPLs are risk factors for progression and complications of extracoronary vascular disease. However, the addition of OxPLs to Lp(a) does not provide additional information about risk of extracoronary vascular disease. Therefore, Lp(a) alone captures the risk profile of Lp(a), OxPL-apoB, and OxPL-apo(a) in the development and progression of atherosclerotic plaque in peripheral arteries.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.