Lp(a) and vascular inflammation: data from perivascular fat attenuation index measurements

Elevated lipoprotein(a) [Lp(a)] values consist an independent cardiovascular risk factor. So far, there are no approved pharmaceutical treatments available to reduce Lp(a) in clinical practice, while antisense oligonucleotides which can induce a drastic reduction of Lp(a) are under phase III clinical study. Based mainly on in-vitro studies, Lp(a) induces inflammation in the vascular wall through deposition in the endothelium, activation of the endothelium, and attraction of monocytes to the vascular wall. However, the relationship of Lp(a) with vascular inflammation is not well documented by clinical data. In the present study, we investigated the relationship of Lp(a) levels with coronary inflammation based on the perivascular fat attenuation index (FAI) from coronary computed tomography angiography (CCTA) images.

In the present study, 40 participants under optimal hypolipidemic treatment who underwent CCTA for clinical reasons were enrolled. Exclusion criteria included history of autoimmune disease with active systemic therapy, chronic treatment with any anti-inflammatory agents, active malignancy, and history of acute coronary syndrome, reperfusion, or NYHA class III/IV heart failure. CCTA images were analyzed for vascular inflammation based on the FAI of perivascular adipose tissue around the right coronary artery.

The group of participants was divided into 2 subgroups, one with Lp(a)≥ 50 mg/dl (n=14) and one with Lp(a)< 50 mg/dl (n=26). There was no statistically significant difference between the 2 subgroups in the incidence of classic cardiovascular risk factors or LDL cholesterol levels. However, patients with elevated Lp(a) had greater FAI values around the right coronary artery (-69.17 vs. -75.26 HU, p= 0.02) (Figure 1).

Higher serum Lp(a) values were associated with increased FAI values around the right coronary artery on CCTA images. These pilot findings highlight the potential role of Lp(a) in vascular inflammation, which should be further explored in future studies.