Epidemiology
Cardiac CT in 207 diabetic patients links elevated Lp(a) to high-risk plaque but not to perfusion or fibrosis (Eur Radiol 2025)
Original title: The impact of lipoprotein(a) level on cardiac pathologies in diabetes: a cardiac CT study
In a prospective cardiac CT study of 207 diabetic patients (mean age 59.1 years, 111 male) who underwent CT angiography, stress myocardial perfusion imaging, and late iodine enhancement, those with elevated Lp(a) (30 mg/dL or above) had a higher percent atheroma volume (2.55% vs. 1.30%, p = 0.010) and a higher incidence of positive remodelling (75.6% vs. 54.8%, p = 0.015), spotty calcification (26.8% vs. 9.6%, p = 0.003), and high-risk plaque (51.2% vs. 30.1%, p = 0.011) than those with normal Lp(a). After adjustment, elevated Lp(a) remained an independent predictor of high-risk plaque (odds ratio 2.608, 95% CI 1.254-5.423, p = 0.010). However, elevated Lp(a) showed no significant relationship with pericoronary adipose tissue density, stress myocardial blood flow, or extracellular volume (markers of perivascular inflammation, perfusion, and fibrosis, respectively). The findings support screening diabetic patients for elevated Lp(a) via coronary CT angiography specifically to characterise atherosclerotic plaque risk, while suggesting Lp(a)'s effects in diabetes are largely confined to plaque composition rather than myocardial tissue changes.
Original abstract
Objectives: We aimed to explore the imaging profile of coronary atherosclerosis, perivascular inflammation, myocardial perfusion, and interstitial fibrosis in diabetes stratified by lipoprotein(a) [Lp(a)] levels.
Methods: In this prospective study, we enrolled diabetic patients who had undergone computed tomography (CT) angiography, stress CT-myocardial perfusion imaging, and late iodine enhancement in 20 months. Then, we categorized them into elevated and normal groups based on an Lp(a) cutoff level of 30 mg/dL. All imaging data, including coronary atherosclerosis parameters, pericoronary adipose tissue (PCAT) density, stress myocardial blood flow (MBF), and extracellular volume (ECV), were collected for further analysis.
Results: In total, 207 participants (mean age: 59.1 ± 12.0 years, 111 males) were included in this study. Patients with elevated Lp(a) level had more pronounced percent atheroma volume (2.55% (1.01-9.01%) versus 1.30% (0-4.95%), p = 0.010), and demonstrated a higher incidence of positive remodeling, spotty calcification, and high-risk plaque (HRP) than those with normal Lp(a) levels (75.6% versus 54.8%, p = 0.015; 26.8% versus 9.6%, p = 0.003; 51.2% versus 30.1%, p = 0.011, respectively). Results of the multivariate analysis revealed that after adjusting for all clinical characteristics, elevated Lp(a) levels were an independent parameter associated with HRP (odds ratio = 2.608; 95% confidence interval: 1.254-5.423, p = 0.010). However, no significant difference was found between the two groups in terms of PCAT density, stress MBF, and ECV.
Conclusions: Elevated Lp(a) levels are associated with extensive coronary atherosclerosis and HRP development. However, they are not related to perivascular inflammation, decreased myocardial perfusion, and interstitial fibrosis in diabetes.
Clinical Relevance Statement: Elevated lipoprotein(a) levels are associated with extensive coronary atherosclerosis and a high incidence of HRPs. However, they are not related to perivascular inflammation, decreased myocardial perfusion, and interstitial fibrosis in diabetes.
Key Points: Diabetes is a known risk factor that accelerates cardiovascular disease progression. Diabetics with elevated lipoprotein(a) (Lp(a)) levels had a higher percent atheroma volume and positive remodeling, spotty calcification, and HRPs. Patients with diabetes should be screened for elevated Lp(a) using CCTA for comprehensive evaluation of atherosclerotic characteristics.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.