Background: While lipoprotein(a) [Lp(a)] has been associated with acute myocardial infarction (MI), the relationship between Lp(a) and the presence of high-risk "vulnerable" coronary plaques has not been studied.
Objectives: We sought to investigate whether specific lipoproteins are associated with pan-coronary plaque volume and lipid deposition vs. the development of non-flow-limiting high-risk vulnerable plaques.
Methods: In PROSPECT II, three-vessel coronary artery imaging was performed with a combined near-infrared spectroscopy and intravascular ultrasound catheter after treatment of all flow-limiting lesions in patients with recent MI. The relationships between total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), HDL-C, Lp(a), and triglycerides with pan-coronary plaque volume, pan-coronary lipid core burden index (LCBI) and the presence of focal vulnerable plaques (plaque burden ≥70% and maximum lipid core burden over any 4 mm segment (maxLCBI4mm) ≥324.7) were assessed in 865 patients.
Results: By multivariable analysis, TC, LDL-C and non-HDL-C (but not Lp(a)) were associated with pan-coronary plaque volume and pan-coronary LCBI (all p<0.01), but not with the presence of vulnerable plaque. Conversely, Lp(a) (but not TC, LDL-C or non-HDL-C) was associated with the presence of focal vulnerable plaques (p=0.01).
Conclusions: In PROSPECT II, elevated TC, LDL-C and non-HDL-C were strongly associated with pan-coronary atherosclerosis and lipid deposition, whereas elevated Lp(a) was strongly associated with the presence of focal vulnerable plaques. These findings may explain the association between high Lp(a) levels and future MI and suggest a unique role for Lp(a) role in atherosclerosis progression and plaque vulnerability.
Editors
Editor-in-Chief
Harlan M. Krumholz, MD, SM, FACC
CME Editor
Ragavendra R. Baliga, MD
Author
Talal Alnabelsi, MD, FACC
Important Dates
Date of Release: May 26, 2025
Term of Approval/Date of CME/MOC Expiration: May 25, 2026