Elevated Lp(a) predicts higher baseline plaque burden and faster low-attenuation plaque growth in 1,694 diabetic patients on serial CT angiography (Eur Radiol 2025)

Original title: Impact of lipoprotein (a) on coronary atherosclerosis and plaque progression in patients with type 2 diabetes mellitus

Eur Radiol · 13 February 2025 · 7

Lan Z, Ding X, Yang W, Yuan J, Yu Y, Yu L, Dai X, Wang Y, Zhang J

This prospective study enrolled 1,694 patients with diabetes mellitus and intermediate pretest probability of coronary artery disease (mean age 62.0 years, 1,031 male) for baseline coronary CT angiography, with 246 undergoing follow-up CCTA a mean 2.3 years later, to assess Lp(a)'s association with plaque characteristics and progression. At baseline, the elevated-Lp(a) group had higher total, noncalcified, low-attenuation, fibro-fatty and fibrotic plaque volumes than the normal-Lp(a) group (all P < 0.001). At follow-up, the elevated-Lp(a) group showed a greater annual increase in low-attenuation plaque volume than the normal-Lp(a) group (3.03 vs. -3.09 mm3 per year, P = 0.011), and multivariate regression confirmed elevated Lp(a) independently predicted accelerated low-attenuation plaque progression after adjustment (beta 4.50, 95% CI 0.06-8.93, P = 0.045). The authors conclude elevated Lp(a) in diabetic patients is linked to higher baseline coronary plaque burden and faster progression of the vulnerable low-attenuation plaque component, supporting Lp(a) modulation as a potential strategy to improve prognosis in this population.

Original abstract

Objectives: To explore the association between baseline Lp (a) levels and high-risk plaques, plaque volume, and plaque progression in patients with diabetes mellitus.

Methods: Patients with diabetes mellitus and intermediate pretest probability of coronary artery disease (CAD) were prospectively enrolled. All patients underwent baseline coronary computed tomography angiography (CCTA), and patients with recurrent symptoms underwent mid-term follow-up CCTA. Plaque quantification and qualification were performed to compare coronary atherosclerosis features and plaque progression between the elevated and normal Lp (a) groups.

Results: In this study, 1694 subjects (mean age: 62.0 ± 7.0 years; 1031 males) were enrolled for baseline analysis, and 246 subjects with repeat CCTA (mean interval of 2.3 ± 0.74 years) were included for follow-up analysis. The total plaque volume, noncalcified plaque volume, low attenuation plaque (LAP) volume, fibro-fatty plaque volume, and fibrotic plaque volume were higher in the elevated Lp (a) group than in the normal Lp (a) group at baseline (all p < 0.001). At follow-up, the elevated Lp (a) group showed a higher mean annual increase in LAP volume than the normal Lp (a) group (3.03 ± 22.26 mm3 vs -3.09 ± 12.22 mm3; p = 0.011). In multivariate linear regression analysis, elevated Lp (a) levels were associated with accelerated LAP volume progression after adjusting for confounders (Beta = 4.50, 95% confidence interval: 0.06-8.93; p = 0.045).

Conclusion: Elevated Lp (a) level in patients with diabetes mellitus was associated with high coronary artery plaque burden at baseline and LAP volume progression at follow-up.

Key Points: Question The relationship between Lp (a) levels and coronary artery plaque volume and progression in patients with diabetes mellitus remains unclear. Findings Elevated Lp (a) level was associated with high total coronary plaque volume at baseline and low-attenuation plaque (LAP) volume progression at follow-up. Clinical relevance Elevated Lp (a) level in patients with diabetes mellitus was associated with high coronary artery plaque burden at baseline and LAP volume progression at follow-up, which supports the modulation of LAP level to improve prognosis.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.