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The association of lipoprotein (a) and coronary artery calcification is more pronounced in women

https://doi.org/10.1007/s00392-025-02625-4

Charlotte Krause (Essen)1, J. Haubold (Essen)2, J. Kampf (Essen)1, L. Umutlu (Essen)2, T. Schlosser (Essen)2, F. Nensa (Essen)3, R. Hosch (Essen)3, J. Straus (Essen)3, I. Dykun (Essen)1, M. Totzeck (Essen)1, T. Rassaf (Essen)1, A.-A. Mahabadi (Essen)1

1Universitätsklinikum Essen Klinik für Kardiologie und Angiologie Essen, Deutschland; 2Universitätsklinikum Essen Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie Essen, Deutschland; 3Universitätsklinikum Essen Institut für Künstliche Intelligenz in der Medizin (IKIM) Essen, Deutschland

 

Background and aims: Evidence for a sex-specific association between elevated Lp(a) and coronary artery calcium (CAC) has been conflicting. We aimed to further investigate the influence of sex and age on this relationship in a clinical cohort.


Methods: We retrospectively analyzed CT datasets of 3985 patients with a clinical CT indication presenting to the University Hospital Essen between 2002 and 2024. For 1682 of these, Agatston score and Lp(a) levels were recorded, 628 (37.3%) were female and 1054 (62.7%) were male patients.
 

Results: Lp(a) values were significantly higher in women compared to men (p=0.008) and in older (>65 years) versus younger women (≤65 years) (p=0.03), whereas no difference with age was seen in men (p=0.529). The regression analysis for association of Lp(a) and CAC was significant for women (p=0.0224) but not for men (p= 0.356) which was confirmed in a multivariate analysis (p-values 0.0273 in women vs. 0.701 in men). In subgroup analysis in older (>65 years) and younger men and women (≤65 years), the association of Lp(a) and CAC reached significance only in women > 65 years (p=0.0265). In women, median Agatston score above 0 was seen with 59 years for women with normal Lp(a) (< 30 mg/dl), but already with 53 years for women with elevated Lp(a) ≥ 30 mg/dl. In men, the median Agatston score was reached only three years earlier with elevated Lp(a) (47 years vs. 50 years of age). 


Conclusions: Our findings indicate a stronger connection of Lp(a) values with CAC in women, especially in older age, and early promotion of atherosclerosis in women with Lp(a) > 30 mg/dl. Furthermore, Lp(a) elevation as cardiovascular risk factor is more frequent in women than in men above the age of 65 years.

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