Elevated Lp(a) predicts higher baseline coronary plaque burden and faster low-attenuation plaque growth on serial CT angiography (Front Cardiovasc Med 2026)

Original title: Lipoprotein(a) and plaque progression: insights from serial coronary computed tomography angiography and quantitative plaque assessment

Front Cardiovasc Med · 1 January 2026 · 7

Chen X, Zheng Y, Lin S, Dai X, Chen Y, Yu S

This retrospective study identified 453 patients (mean age 64.7 years, 77.7% male) with baseline coronary CT angiography between 2009 and 2015 and at least one follow-up CCTA over a median 6.15 years, comparing quantitative plaque metrics between elevated Lp(a) (30 mg/dL or above) and normal Lp(a) groups. Elevated Lp(a) was associated with a higher baseline plaque burden across all measures (all P < 0.001) and with accelerated growth of low-attenuation plaque volume (beta 0.55 mm3/year, 95% CI 0.04-1.06, P = 0.036) after adjustment for confounders. Progression was more pronounced in patients with diabetes, women, those with a family history of coronary disease, those under 60, and those with otherwise normal lipid profiles, while the Lp(a)-calcification link was strongest in statin users. The authors conclude elevated Lp(a) marks accelerated plaque progression even in seemingly low-risk patients, underscoring its value as a residual-risk biomarker on serial imaging.

Original abstract

Background: Lipoprotein(a) [Lp(a)] is a well-established independent risk factor for cardiovascular disease. However, the long-term effects of Lp(a) on coronary plaque phenotype remain unclear.

Objective: To explore the potential association between Lp(a) levels and coronary plaque volume, composition, and progression using coronary computed tomography angiography (CCTA).

Methods: Patients with available data for Lp(a) and underwent baseline CCTA examinations between January 2009 to December 2015 and subsequently underwent a follow-up coronary CTA were retrospectively enrolled. Quantitative CCTA analyses measured plaque length, total plaque volume and composition volume. Patients were categorized into an elevated Lp(a) group (≥30 mg/dL) and a normal Lp(a) group (<30 mg/dL). The association between Lp(a) and baseline plaque characteristic and progression were investigated in linear mixed-effects models adjusted for clinical factors. Subgroup analyses were also conducted.

Results: Among 453 patients (mean age 64.7 years, 77.7% male) with a median follow-up of 6.15 years. elevated Lp(a) was linked to higher baseline plaque burden (all p < 0.001) and accelerated LAP volume progression (β = 0.55 mm3/year, 95% CI: 0.04-1.06; p = 0.036) after adjusting for confounders. In addition, patients with diabetes, female gender, family history of CAD, or aged <60 years and with normal lipid profiles showed higher progression in total plaque volume and LAP, fibro-fatty, and fibrous components. Increased calcification volume progression was also seen in those with diabetes, female gender, smoking, drinking, or normal LDL-C levels. The association between Lp(a) and calcification progression was more pronounced in statin users.

Conclusions: Elevated Lp (a) level was associated with high coronary artery plaque burden at baseline and rapid progression of LAP at follow-up. Lp(a) may serve as a significant residual risk factor in seemingly "low-risk" populations.

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