The Association of Lipoprotein(a) and Coronary Artery Calcium in Asymptomatic Patients: A Systematic Review and Meta-analysis.

AIMS: Lipoprotein(a) [Lp(a)] is an atherogenic lipid particle associated with increased risk for coronary heart disease (CHD) events. Coronary artery calcium (CAC) score is a tool to diagnose subclinical atherosclerosis and guide clinical decision-making for primary prevention of CHD. Studies show conflicting results concerning the relationship between Lp(a) and CAC in asymptomatic populations. We conducted a meta-analysis to evaluate the association of Lp(a) and CAC in asymptomatic patients.

METHODS: We systematically searched PubMed, Embase, and Cochrane until April 2023 for studies evaluating the association between Lp(a) and CAC in asymptomatic patients. We evaluated CAC>0 Agatston units, and CAC>100. Lp(a) was analysed as a continuous or dichotomous variable. We assessed the association between Lp(a) and CAC with pooled odds ratios (OR) adopting a random-effects model.

RESULTS: A total of 23,105 patients from 18 studies were included in the meta-analysis with a mean age of 55.9 years, 46.4% female. Elevated Lp(a) increased the odds of CAC>0 (OR 1.31; 95% CI 1.05 to 1.64; p=0.02), CAC ≥100 (OR 1.29; 95% CI 1.01 to 1.65; p=0.04; ), and CAC progression (OR 1.43; 95% CI 1.20 to 1.70; p<0.01; ). For each increment of 1 mg/dL in Lp(a) there was a 1% in the odds of CAC>0 (OR 1.01; 95% CI 1.01 to 1.01; p<0.01).

CONCLUSIONS: Our findings of this meta-analysis suggest that Lp(a) is positively associated with a higher likelihood of CAC. Higher Lp(a) levels increased the odds of CAC >0. These data support the concept that Lp(a) is atherogenic, although with high heterogeneity and a low level of certainty.

PROTOCOL REGISTRATION: CRD42023422034.