A retrospective imaging study published in the European Journal of Preventive Cardiology examined the relationship between lipoprotein(a) [Lp(a)] levels and coronary plaque characteristics using coronary computed tomography angiography (CCTA).

The analysis included 710 patients who underwent CCTA and had Lp(a) measured between 2008 and 2024. Plaque assessment was performed using a validated artificial intelligence–based quantitative tool. 

Individual plaques served as the unit of analysis, and associations between Lp(a) and plaque features were evaluated using generalized estimating equation models adjusted for traditional cardiovascular risk factors. Outcomes included noncalcified plaque volume, calcified plaque volume, and the presence of high-risk plaque (HRP) features.

The cohort had a mean age of 56±10 years, and 53% were male. A total of 3,642 plaques were identified and analyzed. Elevated Lp(a) levels (≥150 nmol/L) were associated with increased noncalcified plaque volume at the plaque level (p=0.009), whereas no association was observed with calcified plaque volume (p=0.81). 

Elevated Lp(a) was also associated with a higher likelihood of HRP features (adjusted odds ratio [OR] 1.78; 95% CI 1.25–2.54; p=0.001). In contrast, low-density lipoprotein cholesterol (LDL-C) and high-sensitivity C-reactive protein (hs-CRP) were not significantly associated with HRP (p>0.05).

Elevated Lp(a) was independently associated with noncalcified plaque burden and HRP features. These findings suggest a link between Lp(a) and adverse plaque phenotypes identified on CCTA.