Elevated Lipoprotein(a) Linked to Long-Term Progression of Carotid Atherosclerosis

Lipoprotein(a), or Lp(a), is a genetically determined blood lipid and an important risk factor for cardiovascular disease. Its relationship to long-term carotid atherosclerosis has remained unclear, particularly in East Asian populations. Since carotid plaque development and progression to stenosis reflect vascular disease burden, clarifying this relationship could improve risk assessment.

National Cerebral and Cardiovascular Center researchers in Japan evaluated Lp(a) as a blood-based marker linked to carotid atherosclerosis progression. The analysis focused on Lp(a) levels and repeated carotid ultrasound findings in participants from the Suita Study. Lp(a) concentrations were categorized as less than 15, 15–29, 30–49, and at least 50 mg/dL.

Image: The findings indicate that measuring Lp(a) may help identify individuals at increased lifetime risk of atherosclerosis beyond conventional cardiovascular risk factors. (Image Credit: Adobe Stock)

The study included 3,272 participants with no history of cardiovascular disease and no carotid plaque at baseline. Participants underwent repeated carotid ultrasound examinations every two years through June 2016. During a median follow-up of 11.5 years, 1,432 participants developed a new carotid plaque.

Compared with participants whose Lp(a) levels were below 15 mg/dL, those with Lp(a) levels of at least 50 mg/dL had a higher risk of carotid plaque development, with a multivariable-adjusted hazard ratio of 1.27. Participants in the higher Lp(a) group also showed faster annual progression of carotid intima-media thickness. Among participants who developed carotid plaques, Lp(a) levels of at least 50 mg/dL were associated with more than twice the odds of progression to at least 50% carotid stenosis.

Only about 5% of participants had Lp(a) levels of at least 50 mg/dL, but this group showed consistently higher risk across multiple stages of carotid atherosclerosis. The findings suggest that Lp(a) levels of at least 50 mg/dL may be useful for risk stratification even in East Asian populations. The findings were published in the European Journal of Preventive Cardiology on October 7, 2026.

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

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