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Coronary imaging reveals how Lp(a) drives plaque burden and high-risk morphology, review (Curr Atheroscler Rep 2026)
Original title: The Evolving Role of Coronary Artery Imaging in Assessing Cardiovascular Risk from Lipoprotein(a)
Review of coronary artery imaging modalities used to characterise the atherosclerotic and inflammatory manifestations of elevated Lp(a). Lp(a) is associated with coronary artery calcium incidence and progression, greater plaque prevalence, multivessel disease and high-risk plaque morphology on coronary CT angiography, including accelerated progression of mixed and lipid-rich plaque. Intravascular imaging further links Lp(a) to thin-cap fibroatheroma, lipid-rich plaque, percent atheroma volume and plaque progression, and to non-calcified or mixed plaque morphology. The authors conclude that coronary imaging is likely to become an important tool for risk stratification and treatment decisions in people with elevated Lp(a), pending further research.
Original abstract
Purpose Of Review: Summarize current literature on the use of coronary artery imaging modalities in examining the atherosclerotic and arterial inflammatory manifestations of elevated lipoprotein(a) [Lp(a)]. Evaluate the evolving role of coronary imaging in risk stratification and treatment decisions.
Recent Findings: While Lp(a) and calcium scoring (CAC) are independently associated with cardiovascular risk, Lp(a) is associated with CAC incidence and progression. Lp(a) is associated with greater plaque prevalence, multivessel disease, and high-risk morphologies, while also being linked to accelerated progression of mixed and lipid-rich plaque by coronary CT angiography. Intravascular imaging modalities further show associations between Lp(a) and thin-cap fibroatheroma, lipid-rich plaque, percent atheroma volume, and plaque progression. Lp(a) is associated with non-calcified or mixed coronary plaque morphology and progression, as well as increased risk of high-risk plaque features. While additional research is needed, current literature suggests that coronary imaging may be an important tool in cardiovascular risk stratification for individuals with elevated Lp(a).
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Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.