Prevention & lipidsCross-sectional study
Evaluating the role of lipoprotein(a) in enhancing risk stratification for the presence and extent of subclinical coronary artery disease burden: a BioHEART-CT study
- Cross-sectional study
- Optimal threshold by Youden's index with 10,000 bootstraps
Authors' conclusion
Our findings suggest Lp(a)'s role in a new clinical pathway: screening patients considered low or intermediate risk, particularly those without standard modifiable risk factors for non-invasive imaging to detect subclinicalCAD.
Study context
- Population
- Adults undergoing CTCA for suspected CAD enrolled in the BioHEART study
- Participants
- 1,718 adults
- Exposure
- Lp levels and CT measures of subclinical CAD burden
- Outcome
- CAD burden by CACS and Gensini scores; plaque morphology (calcified, non-calcified or mixed)
Main finding
As reported in the abstract
Association of Lp(a) with CTCA measures of CAD
Lp(a) >22 nmol/LOrdinal OR (CI)
more advanced multi-segment disease
1.14(1.03–1.25)
multivessel disease
1.11(1.02–1.20)
- Increased risk of coronary artery calcium score (CACS) >100 per 10 nmol/L Lp(a) increment
- 2.6%
- Association with mixed plaque burden, adjusted for traditional risk factors (not with non-calcified or calcified plaque)
- β = 4.75, p=0.001
- Overall NRI adding Lp(a) to standard risk models
- 16% [0.06-0.27]
- NRI in patients without standard modifiable risk factors
- 42% [0.16-0.70]
Observational data: associations, not effects.
Further findings
Reclassification adding Lp(a) to standard risk models
- Overall NRI
- 16% [0.06-0.27]
- NRI in patients without standard modifiable risk factors
- 42% [0.16-0.70]
Original publication
Evaluating the role of lipoprotein(a) in enhancing risk stratification for the presence and extent of subclinical coronary artery disease burden: a BioHEART-CT study. Eur J Prev Cardiol. Published 3 June 2025. doi:10.1093/eurjpc/zwaf323
Summarised from the published abstract; every number is checked against it