Lipoprotein(a), Coronary Atherosclerotic Plaque, and High-Risk Plaque in Asymptomatic Individuals: The Miami Heart Study at Baptist Health South Florida

Introduction: Affecting approximately 1 in 5 adults, elevated lipoprotein(a) [Lp(a)] levels are independently associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD) events, however, the mechanisms driving this association are not fully understood. Therefore, we examined the association between Lp(a) and coronary plaque characteristics in a diverse U.S. cohort free of clinical ASCVD. Methods: We examined cross-sectional data from the Miami Heart Study, a prospective cohort study in South Florida conducted among asymptomatic adults 40-65 years of age who underwent CCTA. Those taking any lipid-lowering therapies were excluded. High Lp(a) was defined as ≥125 nmol/L. Outcomes included the following: any plaque on CCTA, coronary artery calcium score >0, maximal stenosis ≥50%, presence of any high-risk plaque feature (positive remodeling, spotty calcification, low-attenuation plaque, napkin ring), and the presence of ≥2 high-risk plaque features. Logistic regression models were adjusted for demographics and other cardiovascular risk factors. Results: Among 1,795 participants, 291 (16.2%) had Lp(a) ≥125 nmol/L. In unadjusted analyses, Lp(a) ≥125 nmol/L was associated with a higher prevalence of all outcomes compared with Lp(a) <125 nmol/L, however, differences were only statistically significant for any coronary plaque and the presence of ≥2 high-risk features ( Figure, Panel A ). In multivariable regression models, high Lp(a) was independently associated with the presence of any coronary plaque and ≥2 high-risk features ( Panel B ). Associations for the other outcomes trended in the same direction, however, the confidence intervals included the null. Conclusion: In this contemporary analysis of nearly 1,800 middle-aged asymptomatic adults undergoing CCTA, high Lp(a) was independently associated with any coronary plaque and the presence of multiple high-risk plaques.