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

Lipoprotein(a), or Lp(a), is a genetically determined blood lipid and an important risk factor for cardiovascular disease. However, its association with the long-term progression of carotid atherosclerosis has remained unclear, particularly in East Asian populations. Researchers from the National Cerebral and Cardiovascular Center in Japan have shown that elevated Lp(a) is associated with multiple stages of carotid atherosclerosis, from carotid plaque development to its progression to carotid stenosis. The findings were published in the European Journal of Preventive Cardiology on October 7, 2026.

In this study, the research team analyzed 3,272 participants from the Suita Study who had no history of cardiovascular disease and no carotid plaque at baseline. Participants underwent repeated carotid ultrasound examinations every 2 years through June 2016. Lp(a) levels were categorized as <15, 15–29, 30–49, and ≥50 mg/dL.

During a median follow-up of 11.5 years, 1,432 participants developed a new carotid plaque. Compared to participants with Lp(a) <15 mg/dL, those with Lp(a) ≥50 mg/dL had a higher risk of carotid plaque development, with a multivariable-adjusted hazard ratio of 1.27. They also showed a faster annual progression of carotid intima-media thickness. Among participants who developed carotid plaques, Lp(a) ≥50 mg/dL was associated with more than twice the odds of progression to ≥50% carotid stenosis.

“Our findings suggest that elevated Lp(a) is associated with the continuum of carotid atherosclerosis, from plaque initiation to luminal stenosis," said lead author Masayuki Teramoto. “Measuring Lp(a) may help identify individuals at an increased lifetime risk of atherosclerosis beyond conventional cardiovascular risk factors.”

Although only about 5% of participants had Lp(a) ≥50 mg/dL, this group showed consistently higher risk across multiple stages of carotid atherosclerosis. These findings suggest that Lp(a) ≥50 mg/dL may be useful for risk stratification even in East Asian populations. The study supports the importance of the early identification of individuals with elevated Lp(a) and the careful management of modifiable cardiovascular risk factors, including blood pressure, LDL cholesterol, and diabetes. Further studies are needed to determine whether emerging Lp(a)-lowering therapies can slow carotid atherosclerosis progression or prevent cardiovascular events.

Reference:

Masayuki Teramoto, Yoshihiro Kokubo, Yuka Kato, Sakura Shinohara, Paramita Khairan, Yoko M Nakao, Jun Masui, Kanako Teramoto, Masatoshi Koga, Hiroharu Kataoka, Lipoprotein(a) and the continuum of carotid atherosclerosis from plaque initiation to luminal stenosis: the Suita Study, European Journal of Preventive Cardiology, 2026;, zwag443, https://doi.org/10.1093/eurjpc/zwag443