Elevated lipoprotein(a) is associated with the progression of carotid atherosclerosis

Lipoprotein(a), or Lp(a), is a genetically determined blood lipid that has been linked to an increased risk of cardiovascular disease. However, its role in the long-term progression of carotid atherosclerosis, particularly in East Asian populations, has been uncertain. Researchers from the National Cerebral and Cardiovascular Center in Japan have now shown that elevated Lp(a) levels are associated with the entire process of carotid atherosclerosis, from initial plaque formation to its progression to significant narrowing of the carotid arteries (stenosis).

The study, published in the European Journal of Preventive Cardiology, involved 3,272 Japanese adults without any history of cardiovascular disease or existing carotid plaque. Participants underwent repeated carotid ultrasound examinations every two years, with the average follow-up lasting 11.5 years. Lp(a) levels were categorized into four groups: 15 mg/dL or lower, 15–29 mg/dL, 30–49 mg/dL, and ≥50 mg/dL.

The researchers found that participants with Lp(a) levels of 50 mg/dL or higher had a 27% higher risk of developing new carotid plaques compared to those with levels below 15 mg/dL. These individuals also exhibited a faster annual progression of carotid intima-media thickness. Among those who developed carotid plaques, having Lp(a) levels of 50 mg/dL or higher was linked to more than twice the odds of experiencing ≥50% stenosis in the carotid arteries.

Lead author Masayuki Teramoto concluded that these findings suggest that elevated Lp(a) is indeed associated with the entire continuum of carotid atherosclerosis, from the initial plaque initiation to the final luminal stenosis. Measuring Lp(a) levels could potentially help identify individuals at a higher lifetime risk of atherosclerosis beyond conventional cardiovascular risk factors.

Although only about 5% of the participants had Lp(a) levels of 50 mg/dL or higher, this group consistently showed higher risks across multiple stages of carotid atherosclerosis. The study highlights the importance of early identification of individuals with elevated Lp(a) and the careful management of modifiable cardiovascular risk factors, such as blood pressure, LDL cholesterol, and diabetes.

The researchers also note that further studies are needed to determine whether emerging Lp(a)-lowering therapies could slow the progression of carotid atherosclerosis or prevent cardiovascular events.