{"id":"6ec6f1419a48","type":"article","url":"https://hartvaat.nl/2026/09/26/lagere-non-lp-a-apob-lp-a-verhouding-correleert-met-kwetsbaarder-plaques-prospec/","title":"Lagere non-Lp(a) apoB/Lp(a)-verhouding correleert met kwetsbaarder plaques — PROSPECT II","title_en":"Balance of non-Lp(a) apoB and Lp(a) with Coronary Plaque Phenotypes and MACE: Insights from PROSPECT II and CASABLANCA.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":[],"journal":"European journal of preventive cardiology","doi":"10.1093/eurjpc/zwag512","source_url":"https://doi.org/10.1093/eurjpc/zwag512","authors":["Sotirios Tsimikas","James L Januzzi","Michael Maeng","Thomas Engstrøm","Lars Kjøller-Hansen","Ori Ben-Yehuda","Mitsuaki Matsumura","Hans Erik Bøtker","Ole Fröbert","Jonas Persson","Rune Wiseth","Alf I Larsen","Lisette O Jensen","Jan E Nordrehaug","Øyvind Bleie","Elmir Omerovic","Claes Held","Rebecca Rylance","Yuxi Liu","Stefan K James","Ziad A Ali","Akiko Maehara","Gregg W Stone","David Erlinge"],"significance":5,"published":"2026-10-04","source_date":"2026-09-26","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"In a cohort of 854 patients with recent myocardial infarction, a lower non-Lp(a) apoB to Lp(a) ratio was independently associated with greater coronary plaque burden and higher odds of vulnerable plaque phenotypes (OR 1.62; P=0.011). External validation in the CASABLANCA study confirmed that this ratio identifies an Lp(a)-enriched plaque profile linked to elevated cardiovascular risk. Differentiating between Lp(a)- and non-Lp(a)-derived apoB pools provides complementary insights into plaque vulnerability and may help refine risk stratification in patients with persistent atherosclerotic risk despite lipid-lowering therapy.","created":"2026-09-28T01:07:39Z","updated":"2026-09-28T01:07:39Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Onderzocht bij 854 patiënten met een recent hartinfarct bleek een lagere verhouding tussen non-Lp(a) apoB en Lp(a) onafhankelijk samen te hangen met een grotere plaquebelasting en een hogere kans op kwetsbare plaquekenmerken (OR 1,62; P=0,011). In een externe cohortstudie (CASABLANCA) correleerde deze verhouding met een Lp(a)-enriched fenotype en verhoogd cardiovasculair risico. Het onderscheid tussen Lp(a)- en niet-Lp(a)-gerelateerde apoB-deeltjes biedt aanvullende informatie over plaque-phenotypen en kan helpen bij het stratificeren van patiënten met een verhoogd residuair risico ondanks lipidendaling.","abstract_original":"AIMS: Apolipoprotein B (apoB)-containing lipoproteins contribute heterogeneously to atherosclerosis. While apoB particles are major determinants of plaque burden, Lp(a) has been linked to plaque inflammation and instability. We investigated the associations of non-Lp(a) apoB, Lp(a), and their relative balance with coronary plaque burden and vulnerability. METHODS AND RESULTS: Among 854 patients with recent myocardial infarction enrolled in the PROSPECT II near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) study, total apoB was converted to nmol/L and non-Lp(a) apoB calculated by subtracting Lp(a) in nmol/L. The non-Lp(a) apoB/Lp(a) ratio was used to characterize the relative predominance of these lipoprotein classes. Higher non-Lp(a) apoB was independently associated with greater plaque burden (plaque percentage volume; β = 0.19, 95% confidence interval [CI] 0.05-0.33; P = 0.009), but not with lipid core burden index. In contrast, lower non-Lp(a) apoB/Lp(a) ratio tertile were associated with higher odds of plaque burden ≥70% (odds ratio [OR] 1.47, 95% CI 1.04-2.07; P = 0.029) and the composite vulnerability endpoint of plaque burden ≥70% and maxLCBI4mm ≥324.7 (OR 1.62, 95% CI 1.12-2.33; P = 0.011). In an exploratory external cohort from the CASABLANCA study, lower ratios identified an Lp(a)- and oxidized phospholipid-enriched phenotype and were associated with higher unadjusted cardiovascular risk. CONCLUSIONS: Non-Lp(a) apoB and Lp(a) demonstrate distinct associations with coronary plaque burden and vulnerability. Differentiating Lp(a)-associated from non-Lp(a)-associated apoB particle pools provides complementary information on coronary plaque phenotype, and the non-Lp(a) apoB/Lp(a) ratio summarizes their relative predominance."}