Lipoprotein(a) Selectively Associates with Vulnerable Coronary Plaque Phenotypes in Comparison with Other Established Risk Markers
Abstract Body (Do not enter title and authors here): BACKGROUND Lipoprotein(a) [Lp(a)] is associated with increased cardiovascular risk; however, its contribution to coronary plaque burden and composition, compared to traditional risk enhancers, remains incompletely defined. OBJECTIVES Investigate associations between Lp(a) levels and coronary plaque characteristics in asymptomatic patients, and to compare its predictive value against other cardiovascular disease (CVD) risk enhancers, including LDL particle concentration (LDL-P), high-sensitivity C-reactive protein (hsCRP), and coronary artery calcium (CAC) score. METHODS Retrospective study of asymptomatic patients undergoing coronary computed tomography angiography (CCTA) for primary prevention between 2018–2024. Plaque characteristics were assessed using artificial intelligence-based quantitative CCTA (AI-QCT). Associations between standardized Lp(a), LDL-P, CAC score, hsCRP and plaque volumes were evaluated using linear regression models adjusted for age and sex. RESULTS The cohort included 547 patients (median age 56 years old, 70% male, 50% on statin therapy). In linear regression analyses adjusted for age and sex, higher Lp(a) levels (per 1 SD increase) were significantly associated with greater total plaque volume (β=23.11 mm3, p=0.006), calcified plaque (β=11.13 mm3, p=0.014), non-calcified plaque (β=11.99 mm3, p=0.027), low-density non-calcified plaque (LDNCP) (β=0.43 mm3, p<0.001; Figure 1), maximum diameter stenosis (β=1.37%, p=0.027), area stenosis (β=1.91%, p=0.031), and remodeling index (β=0.02, p=0.017). In a multivariable model, comparing the different CVD risk enhancers, CAC score remained the strongest predictor of total plaque, calcified plaque, and non-calcified plaque volumes (p < 0.0001 for all). However, CAC score was not associated with LDNCP. Elevated Lp(a) levels were independently associated with LDNCP (β=0.45 mm3, p=0.013), even after adjustment for LDL-P, hsCRP, and CAC. Neither LDL-P nor hsCRP were significantly associated with any plaque subtype in the multivariable analysis (Table 1). CONCLUSIONS In asymptomatic primary prevention patients, Lp(a) was independently associated with high-risk coronary plaque features, specifically LDNCP, beyond traditional risk enhancers.
Gurevitz, Chen
( Mount Sinai Health
, New York
, New York
, United States
)
Fisher, Rebecca
( Mount Sinai Health
, New York
, New York
, United States
)
Fisher, Edward
( Mount Sinai Health
, New York
, New York
, United States
)
Park, Jisuk
( Cleerly, Inc.
, Durham
, North Carolina
, United States
)
Min, James
( Cleerly, Inc.
, Durham
, North Carolina
, United States
)
Goonewardena, Sascha
( UNIVERSITY OF MICHIGAN
, Ann Arbor
, Michigan
, United States
)
Rosenson, Robert
( Mount Sinai Health
, New York
, New York
, United States
)
Author Disclosures:
Chen Gurevitz:DO NOT have relevant financial relationships
| Rebecca Fisher:DO NOT have relevant financial relationships
| Edward Fisher:No Answer
| Jisuk Park:No Answer
| James Min:DO have relevant financial relationships
;
Employee:CLEERLY:Active (exists now)
; Consultant:TOURMALINEBIO:Active (exists now)
; Ownership Interest:CLEERLY:Active (exists now)
; Advisor:ARINETA:Active (exists now)
| Sascha Goonewardena:No Answer
| Robert Rosenson:DO have relevant financial relationships
;
Research Funding (PI or named investigator):Amgen:Active (exists now)
; Consultant:Intercept Pharmaceuticals:Past (completed)
; Consultant:Eli Lilly:Active (exists now)
; Consultant:Editas Medicine:Past (completed)
; Consultant:CRISPER Therapeutics:Past (completed)
; Consultant:Arrowhead:Active (exists now)
; Consultant:Amgen:Active (exists now)
; Research Funding (PI or named investigator):Shanghai Argo Biopharmaceutical Co.:Active (exists now)
; Research Funding (PI or named investigator):89Bio:Active (exists now)
; Research Funding (PI or named investigator):Novo Nordisk:Past (completed)
; Research Funding (PI or named investigator):Novartis:Active (exists now)
; Research Funding (PI or named investigator):NIH:Active (exists now)
; Research Funding (PI or named investigator):Merck:Active (exists now)
; Research Funding (PI or named investigator):Eli Lilly:Active (exists now)
; Research Funding (PI or named investigator):Arrowhead:Active (exists now)
