Lp(a) only weakly tracks with coronary calcium, and mainly in men over 65, STAR-Lp(a) study of 528 primary prevention patients finds (J Clin Med 2025)

Background: Available studies have shown a correlation between higher lipoprotein(a) (Lp(a) levels and atherosclerotic diseases. We aimed to evaluate the association between Lp(a) and coronary artery calcification CAC Score among patients referred to outpatient cardiology clinics based on the data from the STAR-Lp(a) study. Methods: The study included consecutive patients referred to two outpatient cardiology clinics. The present analysis included primary prevention patients without atherosclerotic cardiovascular disease who underwent coronary computed tomographic angiography (CCTA). Results: We analyzed 528 patients (median age 68 years, 179 men, 349 women). Overall, 73.9% had Lp(a) < 30 mg/dL, 7.6% had 30-50 mg/dL, and 18.5% ≥ 50 mg/dL. The median coronary artery calcium (CAC) score was 23.5 (IQR 0.0-208.0), with 0 (0.0-40.0) in patients < 65 years and 58 (0.0-357.0) in those ≥65 years. In correlation analyses, Lp(a) was weakly associated with CAC (ρ = 0.11, p-FDR [false discovery rate] = 0.027), with stronger associations in men (ρ = 0.16, p-FDR = 0.011) and patients ≥ 65 years (ρ = 0.17, p-FDR = 0.011). No consistent associations were observed in younger patients or women. In multivariable ordinal logistic regression, age, male sex, smoking, and statin therapy were independent predictors of CAC severity, whereas Lp(a) was not. Similarly, Lp(a) did not predict CAC score of zero. These findings suggest Lp(a) relates to CAC in older men, but not independently of established risk factors. Conclusions: This study found a weak association between Lp(a) levels and coronary artery calcification, evident mainly in patients aged ≥65 years.