Prevention & lipidsMeta-analysis
Use of Coronary Artery Calcium Scoring in Individuals With Elevated Lipoprotein(a)
- Pooled analysis of prospective cohort studies
- 4 US-based prospective cohorts
- multivariable Cox regression
Authors' conclusion
Elevated Lp(a) is associated with higher relative risk across CAC strata, including CAC of 0. Among individuals with CAC of 0, absolute event rates remain low even when Lp(a) is elevated.
Study context
- Population
- Participants without known atherosclerotic cardiovascular disease (ASCVD) with baseline Lp(a) and coronary artery calcium (CAC) measurements1,569 ASCVD events
- Participants
- 11,319 participants
- Comparison
- Lp >50 mg/dL vs ≤50 mg/dL across CAC strata
- Outcome
- Incident ASCVD (MI, stroke, coronary revascularization)
- Follow-up
- 14.8 year mean
Pooled result
As reported in the abstract
Incident ASCVD
Each group vs Lp(a) ≤50 mg/dLHazard ratio (95% CI)
Lp(a) >50 mg/dLindependent of CAC
1.24(1.09–1.41)
CAC >0independent of Lp(a)
2.44(2.14–2.77)
Further pooled results
| Outcome | Lp(a) >50 mg/dL | Lp(a) ≤50 mg/dL | HR (95% CI) | |
|---|---|---|---|---|
| Incident ASCVD, CAC = 0 (subgroup) | 4.9 /1,000 person-years | 3.8 /1,000 person-years | 1.28 (1.01–1.60) | |
| Incident ASCVD, CAC >0 (subgroup) | 21.2 /1,000 person-years | 18.2 /1,000 person-years | 3.03 (2.52–3.64) | |
| Incident ASCVD, CAC ≥300 and Lp(a) >50 mg/dL · greatest risk | 6.12 (4.80–7.81) | |||
| 0.10.31310Hazard ratio (log scale) |
By age and sex
- Consistent results by age and sex; greater absolute risk in >50 years and men
Original publication
Use of Coronary Artery Calcium Scoring in Individuals With Elevated Lipoprotein(a). J Am Coll Cardiol. Published 16 March 2026. doi:10.1016/j.jacc.2026.02.5067
Summarised from the published abstract; every number is checked against it