Lp(a) tracks non-calcified plaque in men but calcified plaque in women, 7201-person asymptomatic CCTA cohort (J Cardiol 2026)

Background: The relationship between lipoprotein(a) [Lp(a)] and sex-specific differences in plaque characteristics and coronary artery disease (CAD) progression remains unclear.

Methods: We retrospectively analyzed 7201 asymptomatic participants (4699 men and 2502 women) without known CAD who underwent coronary computed tomography angiography (CCTA). CCTA was used to evaluate coronary atherosclerotic plaques (calcified, mixed, and non-calcified plaques) and obstructive CAD (diameter stenosis ≥50%). CCTA findings were analyzed according to sex, and the association between Lp(a) levels and coronary atherosclerosis was assessed using tertiles of Lp(a).

Results: In men (n = 4699), the third Lp(a) tertile showed significantly higher adjusted odds ratios (ORs) for non-calcified plaque [1.482, 95% confidence interval (CI) 1.093-2.010] and obstructive CAD (1.399, 95% CI 1.061-1.845) than the first tertile. No significant differences were observed between the calcified and mixed plaques. In women (n = 2502), the third Lp(a) tertile demonstrated significantly higher adjusted ORs for calcified plaques (1.382, 95% CI 1.048-1.821) and obstructive CAD (1.980, 95% CI 1.014-3.867), with no significant differences in mixed and non-calcified plaques.

Conclusions: In asymptomatic individuals, higher Lp(a) levels were associated with non-calcified plaque and obstructive CAD in men and calcified plaque and obstructive CAD in women.