https://doi.org/10.1007/s00392-025-02625-4
1Universitäts-Herzzentrum Freiburg / Bad Krozingen Klinik für Kardiologie und Angiologie Bad Krozingen, Deutschland; 2CCB am AGAPLESION BETHANIEN KRANKENHAUS Medizinisches Versorgungszentrum Frankfurt am Main, Deutschland
Background and Aims: Elevated Lipoprotein(a) (Lp(a)) levels are associated with coronary atherosclerosis as detected by cardiac computed tomography angiography (CCTA). However, quantitative data including coronary plaque volumes and characteristics are scarce. The current study evaluated the correlations between Lp(a) levels and the extent and composition of coronary stenosis and plaques.
Methods: All patients undergoing CCTA (third-generation dual-source scanner) for suspected coronary artery disease were included whose Lp(a) levels were available. Coronary plaque volumes were semi-automatically analysed. Coronary stenoses > 80%, positive remodelling, napkin ring sign, low CT-attenuation, and spotty calcification were defined as high-risk plaque features. Lp(a) values ≥ 125 nmol/L were classified as high.
Results: In a total of 1,946 patients (62.6% male), the median Lp(a) value was 19.0 nmol/L. High Lp(a) levels were observed in 336 patients, who had greater maximum degree of stenosis (49.5±26.4% vs. 43.5±27.6%, P=0.002), mainly as a result of the pronounced difference in males (53.8±26.0% vs. 46.2±26.8%, P=0.001). A strong correlation between higher Lp(a) values and high-risk plaque features was noted overall and in males, independent of age and LDL-cholesterol values. In males, high Lp(a) levels were also associated with increased total plaque volumes (118.1 vs. 83.2 mm³, P=0.018), whereas in women, only a marginal correlation with total plaque volume was observed (19.2 vs. 8.1 mm³; Spearman’s rank correlation R=0.16, P=0.037).
Conclusions: Our study identifies novel sex-specific correlations between Lp(a) levels and coronary plaque characteristics. High Lp(a) levels in men are linked to greater plaque volume, degree of stenosis, and high-risk plaque features. Overall, high Lp(a) levels are associated with plaque volumes and high-risk features in males and a tendency for increased plaque volumes in females.