Mechanisms
Systematic review of 2,058 patients finds elevated Lp(a) consistently linked to vulnerable carotid plaque features (J Stroke Cerebrovasc Dis 2024)
Original title: Association between elevated lipoprotein(a) levels and vulnerability of carotid atherosclerotic plaque: A systematic review
This PRISMA-guided systematic review identified nine eligible studies, five cross-sectional, three prospective or retrospective cohorts, and one randomised controlled trial subanalysis, covering 2,058 patients, examining Lp(a)'s association with vulnerable carotid atherosclerotic plaque features. While two cross-sectional studies directly comparing Lp(a) between patients with and without vulnerable plaque gave discordant results, every study assessing the prevalence or incidence of vulnerable carotid plaque by Lp(a) level found a positive association, and one study also found a significant correlation between plaque vulnerability and Lp(a) concentration. Almost all analysed studies pointed toward elevated Lp(a) being linked to carotid plaque vulnerability, though the authors note further dedicated research is needed given the heterogeneity of study designs and the discordant direct-comparison results.
Original abstract
Background: The role of lipoprotein(a) [Lp(a)] as a potential risk factor for atherosclerotic arterial disease has been extensively studied. However, the available data regarding its association with the vulnerability of carotid atherosclerotic plaque is limited. The main objective of the present systematic review was to assess the association between elevated Lp(a) levels and carotid vulnerable plaque features.
Methods: This systematic review adhered to PRISMA guidelines, conducting a comprehensive literature search to identify studies examining the association between Lp(a) levels and vulnerability of carotid atherosclerotic plaque. Experimental or observational studies were eligible, without language, country, or publication type restrictions.
Results: Nine studies including 2058 patients were eligible for this systematic review. Five cross-sectional studies, 3 prospective/retrospective cohorts, and 1 subanalysis of a randomized controlled trial were analyzed. Two cross-sectional studies that compared Lp(a) levels between patients with and without vulnerable carotid plaque showed discordant results. Nevertheless, all the studies that evaluated the prevalence or incidence of vulnerable carotid plaque according to Lp(a) levels showed a positive association. Similarly, one study found a significant correlation between vulnerability of carotid plaque and Lp(a) levels.
Conclusion: Almost all studies analyzed in the present review showed a positive association between elevated Lp(a) levels and carotid vulnerable plaque features. However, further research is needed to clarify this issue.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.