Epidemiology
Very high Lp(a) carries 67% higher odds of coronary stenosis in patients newly presenting with stable chest pain, Danish Dan-NICAD cohort of 4,346 finds (Am Heart J 2025)
Original title: Elevated lipoprotein(a) levels are independently associated with the presence of significant coronary stenosis in de-novo patients with stable chest pain
This analysis drew on the Dan-NICAD program (three ClinicalTrials.gov-registered studies) to examine 4,346 patients with new-onset stable chest pain and no prior coronary artery disease history, who underwent both Lp(a) measurement and coronary CT angiography, categorised as normal (below 20 nmol/L, 55.6%), moderately elevated (20 to below 125, 29.4%), high (125 to below 200, 9.8%), or very high (200 nmol/L or above, 5.2%) Lp(a). Coronary stenosis prevalence rose with Lp(a) category (23.5%, 25.7%, 30.4%, 33.9% respectively), as did multivessel disease (10.4%, 11.7%, 14.4%, 18.1%). Unadjusted odds ratios for stenosis rose progressively with Lp(a) category (1.12, 1.42, and 1.67 for moderately elevated, high, and very high versus normal), and adjustment for age, sex and cardiovascular risk factors did not change this association. The authors conclude Lp(a) is positively associated with coronary stenosis on CT angiography in stable, symptomatic patients without established coronary disease, supporting its use in diagnostic risk assessment for suspected coronary artery disease.
Original abstract
Background: The role of lipoprotein(a) (Lp(a)) in the risk-assessment of patients with de-novo stable chest pain is sparsely investigated. We assessed the association between Lp(a) concentration and the presence of coronary stenosis on coronary computed tomography (CT) angiography in a broad population of patients referred with stable chest pain.
Methods: Lp(a) measurements and coronary CT angiography were performed in 4,346 patients with stable chest pain and no previous history of coronary artery disease. The patients were included in the trial program, the Danish study of Non-Invasive testing in Coronary artery disease, Dan-NICAD. The prevalence and odds ratios for stenosis were calculated comparing normal Lp(a) (< 20 nmol/l) with moderately elevated (20 to <125 nmol/l), high (125 to <200 nmol/l), and very high (≥200 nmol/l) Lp(a) concentrations in both univariate and multivariate analyses.
Results: In total, 2,418 (55.6%), 1,276 (29.4%), 425 (9.8%), and 227 (5.2%) patients had normal, moderately elevated, high, and very high Lp(a) levels, respectively. The prevalences of coronary stenosis increased with increasing Lp(a) concentration (n = 569 (23.5%), n = 328 (25.7%), n = 129 (30.4%), and n = 77 (33.9%) in patients with normal, moderately elevated, high, and very high Lp(a), respectively). Likewise, the prevalence of patients with multivessel disease increased with increasing Lp(a) concentration (n = 252 (10.4%), n = 149 (11.7%), n = 61 (14.4%), and n = 41 (18.1%) in patients with normal, moderately elevated, high, and very high Lp(a), respectively). In an unadjusted model, odds ratios for stenosis increased with increasing Lp(a) concentrations odds ratio 95% CI: 1.12 (0.96-1.31), 1.42 (1.13-1.77), and 1.67 (1.24-2.22) for moderately elevated, high, and very high Lp(a) versus normal Lp(a), respectively). Adjustment for age, sex, and cardiovascular risk factors did not affect the association.
Conclusions: In stable, symptomatic patients without established coronary artery disease, Lp(a) levels are positively associated with the presence of coronary stenosis on coronary CT angiography. These findings may warrant using Lp(a) in the diagnostic management of patient with suspected coronary artery disease.
Trial Registration: The 3 studies within the Dan-NICAD program are registered on ClinicalTrials.gov: Dan-NICAD, NCT02264717, https://clinicaltrials.gov/study/NCT02264717?term=dan-nicad&rank=1. Dan-NICAD 2, NCT03481712, https://clinicaltrials.gov/study/NCT03481712?term=dan-nicad&rank=3. Dan-NICAD 3, NCT04707859, https://clinicaltrials.gov/study/NCT04707859?term=dan-nicad&rank=2.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.