Lipoprotein(a), Cholesterol, Triglyceride Levels and Vulnerable Coronary Plaques: A PROSPECT II Substudy (JACC May 2025-2)-Article: Lipoprotein(a), Cholesterol, Triglyceride Levels and Vulnerable Coronary Plaques: A PROSPECT II Substudy

Article: Lipoprotein(a), Cholesterol, Triglyceride Levels and Vulnerable Coronary Plaques: A PROSPECT II Substudy

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The PROSPECT II substudy examines the relationship between lipoproteins and coronary plaque vulnerability. Although Lipoprotein(a) (Lp[a]) has been linked to acute myocardial infarction (MI), its association with high-risk coronary plaques hadn't been thoroughly studied prior to this research. The study aimed to explore how lipoproteins relate to coronary plaque volume and lipid content versus their role in the development of high-risk plaques.<br /><br />In 865 patients who recently suffered an MI, the study utilized near-infrared spectroscopy and intravascular ultrasound to assess the impact of lipoproteins on coronary artery conditions. The study found that total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) were significantly associated with overall plaque volume and lipid burden but not with the presence of specific vulnerable plaques. Conversely, high Lp(a) levels were not correlated with the broader plaque or lipid deposits but showed a strong association with focal high-risk plaques known to predict future adverse cardiac events.<br /><br />These findings highlight the distinct roles of Lp(a) in contributing to plaque vulnerability, unlike TC and LDL-C, which are more involved in the general development of atherosclerosis. This suggests a unique pathway through which Lp(a) contributes to coronary artery disease, potentially offering a targeted approach for preventing related cardiac events.<br /> <br />The study underscores the need for potential therapies targeting Lp(a) to reduce the risk of myocardial infarction by specifically addressing plaque vulnerability. Future research should focus on the role of Lp(a)-lowering treatments on plaque composition to enhance cardiovascular outcomes. These insights could drive the development of combined therapies that focus on both LDL-C and Lp(a) to mitigate risks associated with both widespread atherosclerosis and focal vulnerable plaques.

Keywords

Lipoprotein(a)

coronary plaque vulnerability

myocardial infarction

near-infrared spectroscopy

intravascular ultrasound

plaque volume

lipid content

high-risk plaques

cardiac events

atherosclerosis