Epidemiology
Elevated Lp(a) compounds subclinical atherosclerosis risk specifically in diabetic chest-pain patients in China (Cardiovasc Diagn Ther 2025)
Original title: Association between lipoprotein(a) and atherosclerosis with different diabetic status: a cross-sectional study in a Chinese population
In a cross-sectional study of 912 patients presenting with first-episode chest pain at a Chongqing hospital, elevated Lp(a) was independently associated with coronary artery calcium (odds ratio 1.51, 95% CI 1.02-2.24) and carotid arteriopathy (odds ratio 1.77, 95% CI 1.10-2.86) after adjustment. The association strengthened markedly in patients with diabetes: elevated Lp(a) raised the odds of carotid arteriopathy more than threefold (odds ratio 3.38, 95% CI 1.24-9.20) and of increased carotid intima-media thickness (odds ratio 3.67, 95% CI 1.10-12.30), with the highest coronary calcium burden seen above 300 mg/L. No such synergy appeared in prediabetes. The findings support Lp(a)-based risk stratification specifically in patients who already have diabetes rather than prediabetes.
Original abstract
Background: Lipoprotein(a) [Lp(a)] levels and diabetic status have been recognized as risk factors for atherosclerosis. However, no studies on atherosclerosis have integrated these two indicators. This study aimed to evaluate the relationship between Lp(a) levels, diabetic status, and their combined effects on subclinical atherosclerosis.
Methods: This cross-sectional study included patients presenting with a first episode of chest pain at the First Affiliated Hospital of Chongqing Medical University from June 2018 to February 2022. All participants underwent coronary computed tomography angiography (CCTA) and carotid ultrasound to evaluate subclinical atherosclerosis. Logistic regression analysis was used to examine the associations of Lp(a) levels and diabetic status-both individually and in combination-with coronary artery calcium (CAC) and carotid arteriopathy.
Results: Among 912 patients, 473 (51.9%) had CAC and 637 (69.8%) had carotid arteriopathy. After adjusting the confounding variables, elevated Lp(a) levels associated with CAC [odds ratio (OR) 1.51, 95% confidence interval (CI): 1.02-2.24, P=0.040] and carotid arteriopathy (OR 1.77, 95% CI: 1.10-2.86, P=0.02) were statistically significant. After combining diabetic status, almost all Lp(a) levels were significantly associated with CAC and CAC score categories (CAC scores: 0.1-99.9, 100-399.9, ≥400) in the diabetes mellitus (DM) group. In this group, the highest risk for CAC and the most severe CAC score categories were observed in patients with Lp(a) levels of >300 mg/L. Among patients with DM, in the lower Lp(a) level group, the prevalence and severity of CAC were more pronounced than those in the medium Lp(a) level group. Additionally, in patients with DM only, elevated Lp(a) levels were associated with carotid arteriopathy (OR 3.38, 95% CI: 1.24-9.20; P=0.02), increased carotid intima-media thickness (cIMT; OR 3.67, 95% CI: 1.10-12.30; P=0.04), and stable/vulnerable carotid plaque (OR 3.39, 95% CI: 1.09-10.55; P=0.04; OR 3.21, 95% CI: 1.07-9.65; P=0.04). However, there were no significant differences between prediabetes and CAC or carotid arteriopathy.
Conclusions: In patients with chest pain and DM without cardiovascular disease (CVD), Lp(a) level was significantly associated with subclinical atherosclerosis and had a synergistic effect with DM. Notably, lower Lp(a) levels in patients with DM may lead to an additional subclinical atherosclerosis risk, whereas prediabetes does not show the same association. Therefore, these findings highlight the importance of formulating early preventive strategies for subclinical atherosclerosis based on Lp(a) levels and diabetic status.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.