# Verhoogd lipoproteïne(a) geassocieerd met kwetsbare coronaire plaques — meta-analyse

*geplaatst 2026-09-30 · Cholesterol · International journal of cardiology. Heart & vasculature · doi 10.1016/j.ijcha.2026.102013 · https://hartvaat.nl/2026/10/01/verhoogd-lipoproteine-a-geassocieerd-met-kwetsbare-coronaire-plaques-meta-analys/*

Een meta-analyse van 13 observationele studies (6.671 patiënten met CAD) toont aan dat een verhoogd lipoproteïne(a)-niveau sterk geassocieerd is met beeldvormend vastgestelde kwetsbare plaques. Specifiek was hoog Lp(a) verbonden met een hoger risico op thin-cap fibroatheroma (TCFA; OR 2,57), plaqueruptuur (OR 1,71) en een grotere lipidboog op OCT, evenals met spotty calcificatie en het napkin-ring sign op CCTA. Deze bevindingen onderbouwen de pathofysiologische rol van Lp(a) bij atherosclerose en ondersteunen het gebruik van Lp(a)-meting voor risicostratificatie. Of specifieke Lp(a)-verlagende therapieën deze kwetsbare plaques kunnen stabiliseren, blijft een belangrijke vraag voor toekomstig onderzoek.

## English: Association of Elevated Lipoprotein(a) levels with vulnerable plaque features assessed by multimodality coronary imaging in patients with coronary artery disease: A systematic review and Meta-analysis.

A meta-analysis of 13 observational studies (6,671 patients with CAD) demonstrates that elevated lipoprotein(a) levels are strongly associated with imaging-defined vulnerable coronary plaques. High Lp(a) was linked to a significantly increased risk of thin-cap fibroatheroma (OR 2.57), plaque rupture (OR 1.71), and larger lipid arcs on OCT, as well as spotty calcification and napkin-ring signs on CCTA. These findings reinforce the pathophysiological role of Lp(a) in atherosclerosis and support its inclusion in cardiovascular risk stratification. Whether targeted Lp(a)-lowering therapies can modify these high-risk plaque features remains to be determined.

## Abstract (original, from the publication)

BACKGROUND: Coronary artery plaques are the pathological basis of coronary artery disease (CAD), and the rupture of vulnerable plaques and thrombosis are important causes of major adverse cardiovascular events (MACE). Lipoprotein(a) is a lipid particle which has been proven to be related to the risk of MACE, but the association between its level and the specific imaging phenotype of vulnerable coronary artery plaques has not been clearly established. METHODS: We searched PubMed, Embase, and the Cochrane Library databases from inception to June 19, 2026, for observational studies evaluating the association between elevated serum Lp(a) levels and coronary plaque characteristics. For OCT-derived features, we compared the relationship between elevated serum Lp(a) levels and the formation of thin-cap fibroatheroma (TCFA), plaque rupture, maximum lipid arc, and minimum lumen area (MLA) in patients with coronary artery disease. Similarly, for CCTA-derived features, we compared the relationship between elevated serum Lp(a) levels and plaque burden, positive remodeling, spotty calcification, napkin ring sign, and low attenuation plaques (LAPs) in patients with CAD. RESULTS: This meta-analysis included 13 studies involving 6671 patients (7 studies used optical coherence tomography (OCT) and 6 studies used coronary computed tomography angiography). For the primary outcomes, a meta-analysis of 7 OCT studies (n = 1773 patients) showed that elevated Lp(a) was associated with a significantly increased risk of TCFA (OR 2.57; 95% CI 1.54-4.30; I2 = 61%; P = 0.0003). Conversely, a meta-analysis of 5 CCTA studies (n = 3581 patients) revealed no statistically significant difference in plaque burden between the high and normal Lp(a) groups (SMD 0.27; 95% CI -0.01 to 0.56; I2 = 90%; P = 0.06). For secondary outcomes, elevated Lp(a) was significantly associated with a higher risk of OCT-derived plaque rupture (4 studies; OR 1.71; 95% CI 1.25-2.34; I2 = 0%; P = 0.0008) and a larger maximum lipid arc (3 studies; SMD 0.84; 95% CI 0.31-1.38; I2 = 79%; P = 0.002). For CCTA-derived features, elevated Lp(a) was associated with an increased risk of spotty calcification (3 studies, OR 1.78; 95% CI 1.19-2.68; I2 = 14%; P = 0.005), napkin-ring sign (3 studies, OR 1.46; 95% CI 1.05-2.03; I2 = 0%; P = 0.02), and LAPs (3 studies, OR 1.52; 95% CI 1.06-2.17; I2 = 69%; P = 0.02). CONCLUSION: This meta-analysis suggests that high Lp(a) levels are associated with several imaging-defined high-risk coronary plaque features, with the most robust evidence observed for OCT-derived TCFA and plaque rupture. By integrating evidence from both OCT and CCTA, our findings provide a comprehensive imaging-based characterization of the vulnerable plaque phenotype associated with elevated Lp(a), although several CCTA-derived findings should be interpreted cautiously. Further research is needed to determine whether Lp(a)-lowering therapy can modify high-risk coronary plaque features and reduce subsequent cardiovascular events.

Auteurs: Jiayu Zhang, Yang Tang, Yuyang Cao, Queyun Sun, Zhao Ma, Sida Jia, Na Xu, Jinqing Yuan, Ying Song

---
Bron: International journal of cardiology. Heart & vasculature, https://doi.org/10.1016/j.ijcha.2026.102013. Bijgewerkt 2026-09-24T01:03:10Z. 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.