Very high Lp(a) predicts worse coronary plaque burden and higher risk of heart attack, revascularisation and death after angiography, over a median 16.87-year follow-up in 5,118 patients (Eur J Prev Cardiol 2025)

Original title: Outcomes after coronary angiography in individuals with elevated lipoprotein(a)

Eur J Prev Cardiol · 13 November 2025 · 8

Supriami K, Faaborg-Andersen CC, Cho SMJ, Tello-Ayala JR, Abou-Karam R, Pomerantsev E, Viscosi V, Haidermota S, Hornsby W, Natarajan P, Ellinor PT, Honigberg MC et al.

This study followed 5,118 participants with Lp(a) measurement who underwent index invasive coronary angiography between 2000 and 2023, categorising Lp(a) as normal (below 75 nmol/L), intermediate, high, or very high (175 nmol/L or above, present in 973 patients, 19.0%). Compared with normal Lp(a), very high Lp(a) was associated with severe obstructive coronary artery disease (aOR 1.51, 95% CI 1.17-1.96), left main disease (aOR 1.67, 95% CI 1.22-2.29), and a 14.04-point higher Gensini score (95% CI 9.57-18.52). Over a median 16.87-year follow-up, very high versus normal Lp(a) carried higher adjusted hazard of acute myocardial infarction (aHR 1.20), revascularisation (aHR 1.32), in-stent restenosis (aHR 1.28), and all-cause mortality (aHR 1.19); among 798 patients who underwent bypass surgery after angiography, very high Lp(a) more than doubled the likelihood of needing subsequent percutaneous intervention (aHR 2.20). This exceptionally long follow-up quantifies Lp(a)'s substantial, sustained residual risk after angiographic diagnosis.

Original abstract

Aims: Elevated lipoprotein(a) [Lp(a)] is an independent risk factor for coronary artery disease (CAD). Data on long-term outcomes following invasive coronary angiography (ICA) in those with elevated Lp(a) are limited. This study examined the association of Lp(a) levels with clinical outcomes after index ICA, accounting for baseline atherosclerotic plaque burden.

Methods And Results: Data were from participants with Lp(a) measurement who underwent index ICA between 2000 and 2023. Lp(a) levels were categorized as normal (<75 nmol/L), intermediate (75- < 125 nmol/L), high (125- < 175 nmol/L), and very high (≥175 nmol/L). Angiographic characteristics (severity, burden), CAD presentation (stable, acute), and subsequent clinical outcomes [acute myocardial infarction (AMI), revascularization, in-stent restenosis (ISR), and all-cause mortality] were assessed. Among 5118 participants, 973 (19.0%) had very high Lp(a). Compared with normal Lp(a), very high Lp(a) was associated with severe obstructive CAD {adjusted odds ratio (aOR), 1.51 [95% confidence interval (CI), 1.17-1.96]}, left main disease [aOR, 1.67 (95% CI, 1.22-2.29)], and a 14.04-point higher Gensini score (95% CI, 9.57-18.52). During a median (interquartile range) follow-up of 16.87 (6.38-18.99) years, participants with very high vs. normal Lp(a) had higher risk of AMI [adjusted hazard ratio (aHR), 1.20 (95% CI, 1.05-1.37)], revascularization [aHR, 1.32 (95% CI, 1.13-1.56)], ISR [aHR, 1.28 (95% CI, 1.04-1.56)], and mortality [aHR, 1.19 (95% CI, 1.05-1.34)]. Among 798 individuals undergoing coronary artery bypass grafting surgery after index ICA, those with very high vs. other Lp(a) were more likely to require subsequent percutaneous coronary intervention [aHR, 2.20 (95% CI, 1.06-4.58)].

Conclusion: Elevated Lp(a) levels are associated with increased burden of coronary atherosclerosis and significant residual risk for adverse outcomes following ICA, highlighting a need for targeted risk-reduction strategies.

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