High Lp(a) drives greater fibrotic coronary plaque volume in men but not women on CT angiography, COPRODUCTION registry of 1,946 patients finds (Clin Res Cardiol 2025)

Original title: Sex-specific influence of Lipoprotein(a) levels on coronary plaque characteristics: - The COPRODUCTION Registry

Clin Res Cardiol · 9 October 2025 · 7

Breitbart P, Liebetrau C, Grün D, Eggebrecht H, Lindhoff-Last E, Westermann D, Voigtländer T, Schmermund A

The COPRODUCTION registry examined 1,946 patients undergoing coronary CT angiography for suspected coronary artery disease on a third-generation dual-source scanner, classifying Lp(a) of 125 nmol/L or above as high (336 patients) to assess sex-specific correlations with plaque extent and composition. High Lp(a) patients had greater maximum stenosis overall (49.5% vs. 43.5%, P = 0.002), driven mainly by men (53.8% vs. 46.2%, P = 0.001), and higher Lp(a) correlated with high-risk plaque features across the cohort (OR 1.645, 95% CI 1.011-2.593, P = 0.037), independent of age and LDL-C. In men specifically, high Lp(a) was associated with greater total plaque volume (118.1 vs. 83.2 mm3, P = 0.018) including fibrotic components (27.6 vs. 18.2 mm3, P = 0.011), while in women only a marginal correlation with total plaque volume was seen (R = 0.16, P = 0.037). This novel sex-specific pattern suggests Lp(a)'s contribution to plaque burden and composition, particularly its fibrotic component, may be substantially greater in men.

Original abstract

Background: Elevated Lipoprotein(a) Lp(a) levels are associated with coronary atherosclerosis as detected by cardiac computed tomography angiography (CCTA). However, quantitative data including coronary plaque volumes and characteristics are scarce. The current study evaluated the sex-specific correlations between (Lp(a)) levels and the extent and composition of coronary stenosis and plaques.

Methods: 1,946 patients undergoing CCTA (third-generation dual-source scanner) for suspected coronary artery disease were included whose Lp(a) levels were available. Lp(a) values ≥ 125 nmol/L were classified as high.

Results: High Lp(a) levels were observed in 336 patients, who had greater maximum degree of stenosis (49.5 ± 26.4% vs. 43.5 ± 27.6%, P = 0.002), mainly as a result of the pronounced difference in males (53.8 ± 26.0% vs. 46.2 ± 26.8%, P = 0.001). A strong correlation between higher Lp(a) values and high-risk plaque features was noted in the overall cohort (odds ratio [OR]: 1.645; 95% confidence interval [CI]: 1.011 to 2.593; P = 0.037), independent of age and LDL-cholesterol values. In males, high Lp(a) levels were associated with greater total plaque volumes (118.1 [IQR 18.3-284.4] vs. 83.2 [IQR 11.8-226.3] mm3, P = 0.018, Pint = 0.09), including fibrotic components (27.6 [IQR 2.1-109.9] vs. 18.2 [IQR 0.4-65.0] mm3, P = 0.011, Pint = 0.013), whereas in women, only a marginal linear correlation with total plaque volume was observed (19.2 vs. 8.1 mm3; Spearman's rank correlation R = 0.16, P = 0.037).

Conclusions: Our study identifies novel sex-specific correlations between Lp(a) levels and coronary plaque characteristics. High Lp(a) levels in men seems to be associated with increased fibrotic plaque volumes and may contribute to greater total plaque burden and high-risk plaque features.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.