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

Erlinge, David LU orcid ; Tsimikas, Sotirios ; Maeng, Michael ; Maehara, Akiko ; Larsen, Alf Inge ; Engstrøm, Thomas LU ; Kjøller-Hansen, Lars ; Matsumura, Mitsuaki ; Ben-Yehuda, Ori and Bøtker, Hans Erik , et al. (2025) In Journal of the American College of Cardiology 85(21). p.2011-2024
Abstract

Background: Although 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: The aim of this study was to investigate whether specific lipoproteins are associated with pancoronary plaque volume and lipid deposition vs the development of non-flow-limiting high-risk vulnerable plaques. Methods: In PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) II, 3-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.... (More)

Background: Although 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: The aim of this study was to investigate whether specific lipoproteins are associated with pancoronary plaque volume and lipid deposition vs the development of non-flow-limiting high-risk vulnerable plaques. Methods: In PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) II, 3-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 of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), non–high-density lipoprotein cholesterol (HDL-C), HDL-C, Lp(a), and triglycerides to pancoronary plaque volume, pancoronary lipid core burden index (LCBI), and the presence of focal vulnerable plaques (plaque burden ≥70% and maximum LCBI over any 4-mm segment ≥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 pancoronary plaque volume and pancoronary LCBI (P < 0.01 for all), 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 pancoronary 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.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
LDL, lipoprotein(a), myocardial infarction, vulnerable plaque
in
Journal of the American College of Cardiology
volume
85
issue
21
pages
14 pages
publisher
Elsevier
external identifiers
  • scopus:105005173416
  • pmid:40436465
ISSN
0735-1097
DOI
10.1016/j.jacc.2025.04.013
language
English
LU publication?
yes
id
a6ea5f7f-6d61-430a-ad42-0a1937c480fe
date added to LUP
2025-07-30 13:40:37
date last changed
2025-07-31 03:13:13
@article{a6ea5f7f-6d61-430a-ad42-0a1937c480fe,
  abstract     = {{<p>Background: Although 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: The aim of this study was to investigate whether specific lipoproteins are associated with pancoronary plaque volume and lipid deposition vs the development of non-flow-limiting high-risk vulnerable plaques. Methods: In PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) II, 3-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 of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), non–high-density lipoprotein cholesterol (HDL-C), HDL-C, Lp(a), and triglycerides to pancoronary plaque volume, pancoronary lipid core burden index (LCBI), and the presence of focal vulnerable plaques (plaque burden ≥70% and maximum LCBI over any 4-mm segment ≥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 pancoronary plaque volume and pancoronary LCBI (P &lt; 0.01 for all), 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 pancoronary 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.</p>}},
  author       = {{Erlinge, David and Tsimikas, Sotirios and Maeng, Michael and Maehara, Akiko and Larsen, Alf Inge and Engstrøm, Thomas and Kjøller-Hansen, Lars and Matsumura, Mitsuaki and Ben-Yehuda, Ori and Bøtker, Hans Erik and Fröbert, Ole and Persson, Jonas and Wiseth, Rune and Jensen, Lisette O. and Nordrehaug, Jan E. and Trovik, Thor and Jensen, Ulf and Bleie, Øyvind and Omerovic, Elmir and James, Stefan K. and Rylance, Rebecca and Sharma, Tania and Ali, Ziad A. and Stone, Gregg W.}},
  issn         = {{0735-1097}},
  keywords     = {{LDL; lipoprotein(a); myocardial infarction; vulnerable plaque}},
  language     = {{eng}},
  number       = {{21}},
  pages        = {{2011--2024}},
  publisher    = {{Elsevier}},
  series       = {{Journal of the American College of Cardiology}},
  title        = {{Lipoprotein(a), Cholesterol, Triglyceride Levels, and Vulnerable Coronary Plaques : A PROSPECT II Substudy}},
  url          = {{http://dx.doi.org/10.1016/j.jacc.2025.04.013}},
  doi          = {{10.1016/j.jacc.2025.04.013}},
  volume       = {{85}},
  year         = {{2025}},
}