Association of Lipoprotein(a) With Coronary Atherosclerosis and Cardiovascular Events: Findings From the SCAPIS Cohort (JIMG September 2026)-Article: Association of Lipoprotein(a) With Coronary Atherosclerosis and Cardiovascular Events: Findings From the SCAPIS Cohort

Article: Association of Lipoprotein(a) With Coronary Atherosclerosis and Cardiovascular Events: Findings From the SCAPIS Cohort

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This SCAPIS population-based study examined whether elevated lipoprotein(a) [Lp(a)] raises cardiovascular risk mainly by increasing coronary plaque burden or by making plaques more dangerous. The cohort included 28,529 Swedish adults aged 50–64 years without prior cardiovascular disease, with coronary CT angiography available in 25,916. Participants were followed for a median of 7.8 years.<br /><br />High Lp(a) (≥50 mg/dL) was present in 14% of participants. It was associated with more coronary atherosclerosis, including severe/extensive plaque burden, obstructive stenosis, and noncalcified plaque. High Lp(a) also predicted more coronary events (fatal or nonfatal myocardial infarction) and, to a lesser extent, ASCVD events.<br /><br />However, the excess event risk associated with high Lp(a) was largely explained by greater atherosclerotic burden. When analyses accounted for plaque burden, the association between Lp(a) and future events was substantially attenuated and was not significant among individuals who already had coronary atherosclerosis at baseline. Mediation analyses supported a pathway in which Lp(a) increases risk primarily by accelerating plaque development rather than by independently causing plaque vulnerability.<br /><br />The study found that people with high Lp(a) developed atherosclerosis about 2–3 years earlier. Population-attributable analyses suggested that elevated Lp(a) accounted for about 5% of severe atherosclerosis, about 10% of obstructive coronary disease, and around 7% of coronary events.<br /><br />Overall, the authors conclude that Lp(a) mainly drives coronary risk through earlier and greater atherosclerosis burden. They argue that routine Lp(a) measurement and coronary imaging may improve risk stratification, especially for primary prevention in people with elevated Lp(a).

Meta Tag

Concept Lipoproteina

Concept Atherosclerotic Coronary Obstruction

Concept Coronary CT Angiography

Concept Coronary Artery Calcium Score

Concept Future Cardiac Events

Keywords

lipoprotein(a)

Lp(a)

coronary atherosclerosis

coronary plaque burden

coronary CT angiography

cardiovascular risk

myocardial infarction

obstructive stenosis

atherosclerosis progression

risk stratification

Lipoproteina

Atherosclerotic Coronary Obstruction

Coronary CT Angiography

Coronary Artery Calcium Score

Future Cardiac Events