Elevated lipoprotein(a) increases odds of thin-cap fibroatheroma and lipid-rich plaques (Am J Med Sci 2026)

Original title: Association Between Lipoprotein A Levels and Vulnerable Atherosclerotic Plaques

Am J Med Sci · 16 October 2026 · 6

Mahadevan A, Jog HS, Dhananjaya H, Patel M, Marwah MPS, Gandhi MH, Vasudevan SS, Lekkala SP, Mehdi HK, Desai R

This meta-analysis of seven observational studies comprising 1,008 patients found that elevated lipoprotein(a) was associated with greater odds of thin-cap fibroatheroma (OR 2.90, 95% CI 1.63 to 5.18; I²=51.0%) and lipid-rich plaques (OR 3.03, 95% CI 1.53 to 6.00; I²=76.9%) on plaque imaging. The association held across sensitivity analyses and showed no significant subgroup differences between Asian and Western cohorts. These findings should be interpreted cautiously given the heterogeneity and limited number of included studies.

Original abstract

Background: Elevated lipoprotein(a) [Lp(a)] is an established cardiovascular risk factor, but its association with imaging-defined vulnerable plaque features remains incompletely characterized.

Methods: We systematically searched PubMed, Scopus, and Embase for observational studies comparing elevated versus lower Lp(a) levels and reporting thin-cap fibroatheroma (TCFA) or lipid-rich plaques. Random-effects meta-analyses were performed, with the primary TCFA analysis restricted to optical coherence tomography (OCT)-based studies. Sensitivity and geography-based subgroup analyses were also conducted.

Results: Seven studies involving 1,008 patients were included. Elevated Lp(a) was associated with greater odds of TCFA in the primary OCT-based analysis (OR 2.90, 95% CI 1.63 to 5.18; I²=51.0%) and with greater odds of lipid-rich plaques (OR 3.03, 95% CI 1.53 to 6.00; I²=76.9%). Including the MDCTA/MRI study in a TCFA sensitivity analysis yielded a similar association. No significant subgroup differences were observed between Asian and Western studies.

Conclusions: Elevated Lp(a) is associated with imaging-defined features of plaque vulnerability, including TCFA and lipid-rich plaques. These findings should be interpreted cautiously given heterogeneity and the limited number of studies.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 21 October 2026. Methods.