Abstract Background Elevated Lipoprotein(a) (Lp(a)) levels are associated with coronary atherosclerosis as detected by cardiac computed tomography angiography (CCTA). Currently, comprehensive data on the correlation between Lp(a) levels and coronary plaque burden, plaque composition, and the incidence of significant stenosis are lacking. Purpose Purpose of this study was to investigate the baseline correlations between Lp(a) values and extent, severity, and composition of coronary plaque burden in a large outpatient cohort undergoing CCTA for suspected CAD. Furthermore, the aim was to analyze the influence of Lp(a) levels on coronary plaque burden and high-risk features and the potential role of gender in modulating this relationship. 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. Multiple regression analysis was performed to interrogate the data for collinearities with age, sex, and low-density lipoprotein (LDL) cholesterol values. To evaluate potential gender-specific differences, an interaction term was included in the model. The interaction effect was analyzed using the corresponding p-value (Pint). 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 in the overall cohort (odds ratio OR: 1.645; 95% confidence interval CI: 1.011 to 2.593; P=0.037), independent of age and LDL-cholesterol values. In males, high Lp(a) levels were associated with greater total plaque volumes (118.1 IQR 18.3–284.4 vs. 83.2 IQR 11.8–226.3 mm³, P=0.018, Pint=0.09), including fibrotic components (27.6 IQR 2.1–109.9 vs. 18.2 IQR 0.4–65.0 mm³, P=0.011, Pint=0.013), whereas in women, only a marginal linear correlation with total plaque volume was observed (19.2 vs. 8.1 mm³; Spearman’s rank correlation R=0.16, P=0.037). Conclusions This study of a large outpatient cohort undergoing CCTA for suspected CAD reveals novel sex-specific differences between Lp(a) levels and coronary plaque characteristics, suggesting a potential role in modulating these relationships. High Lp(a) levels in men are associated with increased fibrotic plaque volumes and may contribute to greater total plaque burden and the occurrence of high-grade stenoses. In women, only a marginal linear correlation between Lp(a) values and total plaque volumes was seen.Correlation Lp(a) & high-grade stenosis Spearman’s rank correlation coefficients
Breitbart et al. (Sat,) studied this question.