Sex-Specific Prognostic Differences Between Coronary Artery Calcium Score (CACS) and Lp(a) in Atherosclerotic Cardiovascular Disease Events: The MESA Study
Authors' conclusion
Although both Lp(a) and CACS independently predict ASCVD risk in both sexes, the predictive value of Lp(a) varies significantly between men and women across different CACS categories.
Study context
- Population
- Participants of the Multi-Ethnic Study of Atherosclerosis465 ASCVD events
- Participants
- 4,651 participants
- Exposure
- Prognostic value of Lp vs CACS for ASCVD events, by sex
- Outcome
- ASCVD events
- Follow-up
- Median 13.84 years
Methodological detailssecondary analysis of MESA, multivariable Cox regression, sex-stratified
- Secondary analysis of MESA
- Multivariable Cox regression
- Sex-stratified
Main finding
As reported in the abstract
Incremental prognostic value of CACS over Lp(a) (C-index)
| Group | Value | C-index CACS vs Lp(a) |
|---|---|---|
| Men | 272 events | 0.732 versus 0.714 |
| Women | 193 events | 0.776 versus 0.762 |
Value
Men272 events
Women193 events
C-index CACS vs Lp(a)
Men0.732 versus 0.714
Women0.776 versus 0.762
- CACS incremental over Lp(a) in men
- P = 0.011
- CACS not incremental over Lp(a) in women
- P = 0.069
Observational data: associations, not effects.
Further findings
Elevated Lp(a) and ASCVD risk, men with CACS >400 (subgroup)
| Adjusted HR (95% CI) | P value | ||
|---|---|---|---|
| Elevated Lp(a)No association in men with CACS ≤400 | 1.822 (1.041–3.189) | P = 0.036 | |
| 0.20.5125Adjusted hazard ratio (log scale) |
Elevated Lp(a) and ASCVD risk, women with CACS >100 (subgroup)
| Adjusted HR (95% CI) | P value | ||
|---|---|---|---|
| Elevated Lp(a) | 1.877 (1.130–3.118) | P = 0.015 | |
| 0.20.5125Adjusted hazard ratio (log scale) |
Original publication
Sex-Specific Prognostic Differences Between CACS and Lp(a) in Atherosclerotic Cardiovascular Disease Events: The MESA Study. Circ Cardiovasc Imaging. Published 6 November 2025. doi:10.
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