Work

Lipoprotein(a), carotid intima– media thickness, and atherosclerotic cardiovascular disease

Year: 2026

Type: article

Abstract: Background Lipoprotein(a) [Lp(a)] is a causal risk factor for atherosclerotic cardiovascular disease (ASCVD), yet its relationship with subclinical atherosclerosis remains poorly characterized. We tested whether Lp(a) is independently and continuously associated with carotid intima-media thickness (CIMT) and whether elevated Lp(a) and CIMT are jointly associated with incident ASCVD. Methods We analyzed European-ancestry UK Biobank participants free of ASCVD at time of imaging. Cross-sectional associations between Lp(a) and CIMT variables were evaluated using linear regression adjusted for age, sex, and cardiovascular risk factors. Incident ASCVD (a composite of coronary artery disease, myocardial infarction, stroke, and peripheral vascular disease) was assessed using Cox proportional hazards models, with analyses stratified by Lp(a) status (≥100 vs. <100 nmol/L) and median CIMT. Results Among 61,193 participants (mean age at imaging 66 years; 47% male), 16% had elevated Lp(a) (≥100 nmol/L). In adjusted models, Lp(a) was independently associated with maximum CIMT (beta 1.82 µm per 1-unit increase in log Lp(a); 95% CI, 0.76-2.88; p < 0.001), with similar associations across several CIMT measures and after adjustment for arterial stiffness. Each 1-SD increase in maximum CIMT increased ASCVD risk by 21% (HR 1.21; 95% CI, 1.13–1.30; p < 0.001). In analyses using low Lp(a)/low CIMT as the reference, high Lp(a)/high CIMT conferred the greatest ASCVD risk (HR 1.80; 95% CI 1.41–2.32; p < 0.001), while high Lp(a)/low CIMT was associated with a non-significant increase (HR 1.23; 95% CI 0.87–1.74; p = 0.24). Conclusion In individuals free of cardiovascular disease, we demonstrate a continuous, independent association between Lp(a) and CIMT. We also demonstrate that elevated Lp(a) and elevated CIMT are jointly associated with the highest incidence of ASCVD.

Source: American Journal of Preventive Cardiology

DOI: 10.1016/j.ajpc.2026.101810

Authors: Nicholas Koran, Khalil Anchouche, Line Dufresne, James C. Engert, George Thanassoulis

Institutions: McGill University, McGill University Health Centre, Research Institute of the McGill University Health Centre

Language: English

Topic: Lipoproteins and Cardiovascular Health

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,900