Inflammation
Elevated Lp(a) combined with a high monocyte count carries the greatest risk of carotid plaque progression in premature coronary disease, 102-patient study finds (Diseases 2025)
Original title: Lipoprotein(a) and Blood Monocytes as Factors for Progression of Carotid Atherosclerosis in Patients with Premature Coronary Heart Disease
This study followed 102 patients with coronary heart disease that began before age 55 in men or 60 in women, who underwent two carotid duplex scans a median 5 years apart, to test whether Lp(a) and blood monocyte count jointly predict carotid atherosclerosis progression (new plaque or over 10% increase in stenosis). Carotid progression occurred in 70 patients, and Lp(a) was the only lipid parameter that differed between those with and without progression, being higher in the progression group. The odds of progression were highest in patients with both elevated Lp(a) and a monocyte count above the median (OR 16.8, 95% CI 3.4-83.0, P < 0.001); progression was also associated with a lymphocyte-monocyte ratio below 4.18 combined with elevated Lp(a) (OR 4.3, 95% CI 1.1-17.2, P = 0.04), but not with low Lp(a) (below 30 mg/dL) plus an above-median ratio. The authors conclude that combining Lp(a) with routine monocyte-based inflammatory markers substantially sharpens prediction of carotid atherosclerosis progression in patients with premature coronary disease.
Original abstract
Background: Elevated lipoprotein(a) [Lp(a)] levels are a key factor in the early formation and progression of atherosclerosis. Monocytes in individuals with an elevated Lp(a) level are represented by an activated inflammatory phenotype and have an increased ability for transendothelial migration. This work studies the association between Lp(a), monocytes, and the progression of carotid atherosclerosis in patients with premature coronary heart disease (CHD).
Methods: This study included 102 patients with CHD manifested before 55 in men and 60 in women who underwent two carotid duplex scans with an interval of 5 [3; 8] years. The criteria for the progression of carotid atherosclerosis were the appearance of new plaque and an increase in stenosis by >10% in any of the six segments. The lipid profile, Lp(a), and hematology with the calculation of the lymphocyte-monocyte ratio (LMR) were determined in all the patients.
Results: The median blood monocyte count was 0.54 × 109/L, and the median LMR was 4.18. In 70 patients, we revealed the criteria for carotid atherosclerosis progression. The groups did not differ by demographics, risk factors, or the blood lipid and lipoprotein levels, except for Lp(a); this concentration was higher in the patients with carotid atherosclerosis progression. The odds of atherosclerosis progression were highest in the patients with an elevated Lp(a) level and a blood monocyte count above the median (16.8, 3.4-83.0, p < 0.001). Carotid atherosclerosis progression was associated with LMR < 4.18 and an elevated Lp(a) level (OR = 4.3, 1.1-17.2, p = 0.04) and not associated with the patients with Lp(a) levels < 30 mg/dL and an LMR above the median.
Conclusions: An elevated Lp(a) level and monocyte count provide the highest probability of the progression of carotid atherosclerosis in patients with premature CHD.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.