Association of advanced coronary artery calcification assessed by coronary artery calcium scoring with lipoprotein (a) and carotid atherosclerosis in asymptomatic patients.

BACKGROUND AND AIM: Elevated Lp(a) is identified an independent risk factor for atherosclerosis. Coronary artery calcium scoring has become a routine clinical test in preventive cardiology to predict subclinical atherosclerotic cardiovascular disease. The link between these two entities is not fully understood. The present study evaluates the association between exposure to a high circulating level of Lp(a) (≥50 mg/dl or ≥125 nmol/L) and advanced coronary artery calcification defined by a coronary artery calcium score ≥400 Agatston Unit in asymptomatic patients.

METHODS AND

RESULTS

A retrospective analysis was performed on 3697 subjects admitted for primary prevention and who underwent coronary artery calcium scoring, carotid arteries doppler ultrasound and at least one Lp (a) measurement between November 2015 and November 2024. The study population was divided into two groups: the non-pooled group including participants with CACS≥ 400AU versus the pooled group including participants with (100AU ≤ CACS<400AU) and (0≤CACS<100AU). Lp(a) was analysed as dichotomous and continuous variable. The mean of Lp(a) (42 ± 21<47 ± 26<58 ± 31 mg/dl, p = 0.351), the proportion of patients with high Lp(a) (25.1% < 26.5%<31.6%, p = 0.004) and the prevalence of carotid atherosclerosis (15.6% < 31%<45.7%, p = 0.001) increase while passing from low (0-99AU) to moderate (100-399AU) to high (≥400AU) CACS, respectively. Only the difference in means of Lp(a) among subgroups failed to achieve the statistical significance. The adjusted logistic regression model revealed a significant association between CACS≥400AU and Lp(a) when analysed either as dichotomous variable [adjusted OR = 1.666, 95%CI(1.342-2.070), p = 0.001] or continuous variable [adjusted OR = 1.041, 95%CI(1.011-1.071), p = 0.007] and carotid atherosclerosis [adjusted OR = 2.212, 95%CI(1.804-2.713), p = 0.001], respectively. The Spearman's Correlation Coefficient showed a weak positively significant correlation between CACS and Lp(a) (ρ = 0.052, p = 0.001).

CONCLUSION

High circulating level of Lp(a) is a marker of advanced coronary artery calcification in patients who are not recognized for cardiovascular disease.