Mechanisms
Elevated Lp(a) impairs coronary flow reserve, a marker of subclinical vasomotor dysfunction, in a 25-versus-30-patient comparison (Expert Rev Cardiovasc Ther 2025)
Original title: The effect of lipoprotein (a) elevation on coronary flow reserve
This prospective study compared 25 patients with elevated Lp(a) against 30 with normal Lp(a) to test whether elevated Lp(a) contributes to subclinical atherosclerosis, using coronary flow reserve (CFR) measured by conventional echocardiography as the main outcome. CFR was significantly lower in the elevated-Lp(a) group than controls (2.0 ± 0.5 vs. 2.5 ± 0.6, P < 0.001), and a significant negative correlation was found between Lp(a) level and CFR (r -0.657, P < 0.001), meaning higher Lp(a) tracked with worse coronary vasomotor function. The authors conclude elevated Lp(a) is significantly associated with subclinical atherosclerosis and impaired coronary microvascular function, supporting the rationale that Lp(a)-lowering therapies could reduce atherosclerotic risk in part by improving coronary vasomotor function, though the small sample size warrants confirmation in larger cohorts.
Original abstract
Background: Lipoprotein (Lp)(a) is a genetically inherited lipoprotein implicated in the progression of cardiovascular diseases and atherosclerosis. This study aims to examine whether elevated Lp(a) levels contribute to the development of subclinical atherosclerosis, compared to individuals with normal Lp(a) levels, using parameters such as coronary flow reserve (CFR).
Research Design And Methods: The study population included 25 patients with elevated Lp(a) levels and 30 subjects with normal Lp(a) levels, recruited prospectively. Conventional echocardiographic measurements were performed according to established guidelines. Main outcome measures included the comparison of CFR values between the groups.
Results: The CFR was found to be significantly decreased in the group with elevated Lp(a) levels compared to the control group (2.0 ± 0.5 vs. 2.5 ± 0.6, p < 0.001). Additionally, a negative and statistically significant correlation was observed between Lp(a) levels and CFR, indicating that higher Lp(a) levels are associated with lower CFR values (r: -0.657, p < 0.001).
Conclusions: Our study demonstrates that elevated Lp(a) levels are significantly associated with subclinical atherosclerosis and impaired coronary vasomotor function. These findings suggest that lowering Lp(a) levels could effectively reduce the risk of atherosclerotic disease by targeting its role in atherosclerosis pathogenesis.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.