Elevated lipoprotein(a) is independently associated with aortic plaque rupture assessed by non-obstructive general angioscopy (Atheroscler Plus 2026)

Original title: Association between serum lipoprotein(a) levels and aortic vulnerable plaques assessed by non-obstructive general angioscopy

Atheroscler Plus · 12 September 2026 · 6

Kojima K, Tanaka Y, Fukumoto K, Ebuchi Y, Nishiwaki T, Kurito N, Tomimatsu S, Hotsubo Y, Nagao T, Sumida R, Mizobuchi S, Migita S et al.

This observational cohort study enrolled 276 consecutive patients with coronary artery disease who underwent non-obstructive general angioscopy. Using a 30 mg/dL cutoff, 27% had elevated lipoprotein(a) and 14% had markedly elevated levels above 50 mg/dL. Patients with elevated lipoprotein(a) showed a significantly higher prevalence of plaque rupture (84% vs. 62%, p < 0.001), thrombus, and fissure compared with lower levels. Multivariate analysis confirmed an independent association with plaque rupture after adjustment for traditional cardiovascular risk factors, indicating persistent aortic plaque vulnerability despite intensive low-density lipoprotein cholesterol lowering.

Original abstract

Background And Aims: Elevated lipoprotein(a) [Lp(a)] levels are recognized as a genetic risk factor for atherosclerotic cardiovascular disease. Previous coronary imaging studies have linked elevated Lp(a) levels to vulnerable coronary plaque characteristics. However, the relationship between elevated Lp(a) levels and vulnerable aortic plaque characteristics remains unclear. We investigated the association between serum Lp(a) levels and vulnerable aortic plaque characteristics assessed by non-obstructive general angioscopy (NOGA).

Methods: We analyzed 276 consecutive patients with coronary artery disease who underwent NOGA between December 2014 and March 2023. Patients were divided according to serum Lp(a) levels using a 30 mg/dL cutoff. Vulnerable aortic plaque characteristics, including plaque rupture, thrombus, yellow plaque, ulceration, and fissure, were assessed by NOGA.

Results: Elevated Lp(a) levels (>30 mg/dL) were observed in 27% of patients, whereas markedly elevated Lp(a) levels (>50 mg/dL) were observed in 14%. Patients with elevated Lp(a) levels showed a significantly higher prevalence of plaque rupture (84% vs. 62%, p < 0.001), thrombus, and fissure than those with lower Lp(a) levels. In contrast, the prevalence of yellow plaque did not differ significantly between groups. The prevalence of plaque rupture progressively increased according to Lp(a) strata. In multivariate logistic regression analysis, elevated Lp(a) levels remained independently associated with plaque rupture after adjustment for traditional cardiovascular risk factors.

Conclusions: Elevated serum Lp(a) levels were independently associated with aortic plaque rupture assessed by NOGA. These findings suggest that elevated Lp(a) levels may be associated with persistent aortic plaque vulnerability despite intensive LDL-C lowering.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 6 October 2026. Methods.