Testing
In 44,354 Korean adults, having both high Lp(a) and coronary calcium raises ASCVD odds 2.4-fold, more than either marker alone (J Clin Lipidol 2025)
Original title: Association of lipoprotein(a) and coronary artery calcium with atherosclerotic cardiovascular disease
This cross-sectional study of 44,354 participants (mean age 40.6 years, 72.8% male) in the Kangbuk Samsung Health Study, conducted between 2010 and 2019, examined the joint association of Lp(a) and coronary artery calcium score (CACS) with atherosclerotic cardiovascular disease (ASCVD) in an Asian population. High Lp(a) (120 nmol/L or above, 11.9% of the cohort) and CACS above zero (15.7% of the cohort) were each independently associated with prevalent ASCVD (odds ratio 1.36, 95% CI 1.02-1.81, and odds ratio 1.79, 95% CI 1.40-2.30, respectively). Those with both high Lp(a) and CACS above zero had the highest ASCVD odds (odds ratio 2.40, 95% CI 1.58-3.63), while high Lp(a) alone with a CACS of zero did not significantly raise ASCVD odds (odds ratio 1.36, 95% CI 0.90-2.05). The findings support additive risk assessment combining Lp(a) and coronary calcium scoring, and extend this joint-marker evidence to an Asian population for the first time at this scale.
Original abstract
Background: A combined evaluation of the associations of lipoprotein(a) (LP[a]) and coronary artery calcium score (CACS) with atherosclerotic cardiovascular disease (ASCVD) has not been conducted in the Asian population.
Objective: We explored whether elevated LP(a) levels and CACS are independently and jointly associated with ASCVD.
Methods: This cross-sectional study included 44,354 participants (mean age 40.6 years, 72.8% male) from the Kangbuk Samsung Health Study, conducted between March 2010 and December 2019, who were tested for LP(a) and CACS. High LP(a) was defined as LP(a) ≥120 nmol/L, and CACS categories were divided as CACS = 0 vs CACS > 0. ASCVD was identified as physician-diagnosed or -treated angina pectoris, myocardial infarction, or ischemic stroke.
Results: The prevalence of high LP(a), CACS >0, and ASCVD was 11.9%, 15.7%, and 1.1%, respectively. Multivariable regression analyses indicated that high LP(a) and CACS >0 were independently associated with prevalent ASCVD (odds ratio [95% CI], 1.36 [1.02, 1.81] and 1.79 [1.40, 2.30], respectively). Compared with individuals with low LP(a)/CACS = 0, those with high LP(a)/CACS > 0 had the highest odds ratio for ASCVD (2.40 [1.58, 3.63]), as did those with low LP(a)/CACS > 0 (1.79 [1.38, 2.33]). However, high LP(a)/CACS = 0 did not significantly increase the odds ratio for ASCVD (1.36 [0.90, 2.05]).
Conclusion: High LP(a) levels and the presence of CAC are independently associated with ASCVD. Given that both markers were additively associated with ASCVD when elevated, more aggressive management to reduce cardiovascular risk may be warranted. Longitudinal studies are necessary to clarify the combined causal relationship between these 2 markers and cardiovascular events in the Asian population.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.