Mechanisms
When Lp(a) dominates a patient's atherogenic particle burden, multivessel coronary disease becomes more likely, 420-patient ACS study finds (Atherosclerosis 2025)
Original title: Atherogenic responsibility of lipoprotein (a) and other apolipoprotein B-containing lipoproteins in acute coronary syndrome
This observational study of 420 hospitalised patients with acute coronary syndrome and obstructive coronary disease (22.4% female, mean age 65.5 ± 12.0 years) measured molar apoB and Lp(a) to calculate the non-Lp(a) apoB/Lp(a) ratio, a proposed indicator of which apoB-containing lipoprotein class contributes more to a given patient's atherogenic burden (ratio above 5 implicating non-Lp(a) apoB, at or below 5 implicating Lp(a)). Among 301 patients (71.7%) with Lp(a) at or below 125 nmol/L, all had a ratio above 5, while among 119 patients (28.3%) with Lp(a) above 125 nmol/L, 47 (39.5%) had a ratio at or below 5, indicating Lp(a)-predominant atherogenicity. A ratio at or below 5, reflecting Lp(a) predominance, was independently associated with multivessel coronary artery disease (OR 2.317, 95% CI 1.051-5.109, P = 0.037), even though a ratio above 5 still prevailed overall, including among patients with elevated Lp(a). This individualised ratio may help identify which patients' residual risk is specifically Lp(a)-driven.
Original abstract
Background And Aims: The atherogenicity of a lipoprotein (a) particle [Lp(a)] appears to be at least 5 times higher than that of apolipoprotein B (apoB)-containing lipoproteins other than Lp(a) [non-Lp(a) apoB]. The non-Lp(a) apoB/Lp(a) ratio could be considered an indicator of the relative atherogenic contribution of each lipoprotein group. Our aim was to evaluate the non-Lp(a) apoB/Lp(a) ratio in patients with acute coronary syndrome (ACS) and the clinical features associated with this ratio.
Methods: Observational study of hospitalised patients with ACS and obstructive coronary artery disease, in whom the molar concentration (nmol/l) of apoB and Lp(a) was determined. Non-Lp(a) apoB was calculated by subtracting Lp(a) from apoB, as well as the ratio of non-Lp(a) apoB/Lp(a), which, depending on whether it was >5 or ≤5, was considered suggestive of greater atherogenic liability of non-Lp(a) apoB or Lp(a), respectively.
Results: We included 420 patients (22.4 % female; 65.5 ± 12.0 years). Lp(a) was ≤125 nmol/L in 301 (71.7 %), in all of them the non-Lp(a) apoB/Lp(a) ratio was >5. On the other hand, Lp(a) was >125 nmol/L in 119 patients (28.3 %) and, in this group, the non-Lp(a) apoB/Lp(a) ratio was ≤5 in 47 (39.5 %). In contrast to Lp(a) levels >125 nmol/l, non-Lp(a) apoB/Lp(a) ratio ≤5 was independently associated with multivessel coronary artery disease (OR = 2.317; CI95 %, 1.051-5109; p = 0.037).
Conclusions: In patients with ACS, even those with elevated Lp(a), a non-Lp(a) apoB/Lp(a) ratio >5 prevails, suggesting greater atherogenic contribution of non-Lp(a) apoB. The predominance of Lp(a) atherogenic responsibility is associated with multivessel coronary artery disease.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.