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The impact of lipoprotein(a) level on cardiac pathologies in diabetes: a cardiac CT study

  • Cardiac
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

We aimed to explore the imaging profile of coronary atherosclerosis, perivascular inflammation, myocardial perfusion, and interstitial fibrosis in diabetes stratified by lipoprotein(a) [Lp(a)] levels.

Methods

In this prospective study, we enrolled diabetic patients who had undergone computed tomography (CT) angiography, stress CT–myocardial perfusion imaging, and late iodine enhancement in 20 months. Then, we categorized them into elevated and normal groups based on an Lp(a) cutoff level of 30 mg/dL. All imaging data, including coronary atherosclerosis parameters, pericoronary adipose tissue (PCAT) density, stress myocardial blood flow (MBF), and extracellular volume (ECV), were collected for further analysis.

Results

In total, 207 participants (mean age: 59.1 ± 12.0 years, 111 males) were included in this study. Patients with elevated Lp(a) level had more pronounced percent atheroma volume (2.55% (1.01–9.01%) versus 1.30% (0–4.95%), p = 0.010), and demonstrated a higher incidence of positive remodeling, spotty calcification, and high-risk plaque (HRP) than those with normal Lp(a) levels (75.6% versus 54.8%, p = 0.015; 26.8% versus 9.6%, p = 0.003; 51.2% versus 30.1%, p = 0.011, respectively). Results of the multivariate analysis revealed that after adjusting for all clinical characteristics, elevated Lp(a) levels were an independent parameter associated with HRP (odds ratio = 2.608; 95% confidence interval: 1.254–5.423, p = 0.010). However, no significant difference was found between the two groups in terms of PCAT density, stress MBF, and ECV.

Conclusions

Elevated Lp(a) levels are associated with extensive coronary atherosclerosis and HRP development. However, they are not related to perivascular inflammation, decreased myocardial perfusion, and interstitial fibrosis in diabetes.

Clinical relevance statement

Elevated lipoprotein(a) levels are associated with extensive coronary atherosclerosis and a high incidence of HRPs. However, they are not related to perivascular inflammation, decreased myocardial perfusion, and interstitial fibrosis in diabetes.

Key Points

  • Diabetes is a known risk factor that accelerates cardiovascular disease progression.

  • Diabetics with elevated lipoprotein(a) (Lp(a)) levels had a higher percent atheroma volume and positive remodeling, spotty calcification, and HRPs.

  • Patients with diabetes should be screened for elevated Lp(a) using CCTA for comprehensive evaluation of atherosclerotic characteristics.

Graphical Abstract

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Abbreviations

CAD:

Coronary artery disease

CAD-RADS:

Coronary artery disease—reporting and data system

CCTA:

Coronary computed tomography angiography

CT-MPI:

Computed tomography—myocardial perfusion imaging

ECV:

Extracellular volume

HRP:

High-risk plaque

LAP:

Low-attenuation plaque

LIE:

Late iodine enhancement

Lp(a):

Lipoprotein(a)

MACE:

Major adverse cardiac event

MBF:

Myocardial blood flow

NRS:

Napkin-ring sign

PCAT:

Peri-coronary adipose tissue

PR:

Positive remodeling

SC:

Spotty calcification

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Funding

This study is supported by National Natural Science Foundation of China (Grant No.: 82271990), The National Key Research and Development Program of China (Grant No.: 2021YFF0501402), Shenkang three-year project of clinical innovation (Grant No.: SHDC2022CRD016), and Shanghai Health Commission Discipline Leader Project (Grant No.: 2022XD031).

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Author notes

  1. Jiajun Yuan and Xiaoying Ding contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, #85 Wujin Rd, Shanghai, China

    Jiajun Yuan, Wenli Yang, Ziting Lan, Yarong Yu, Lihua Yu, Xu Dai & Jiayin Zhang

  2. Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, #85 Wujin Rd, Shanghai, China

    Xiaoying Ding & Yufan Wang

Authors
  1. Jiajun Yuan
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  2. Xiaoying Ding
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  9. Jiayin Zhang
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Corresponding authors

Correspondence to Yufan Wang or Jiayin Zhang.

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Guarantor

The scientific guarantor of this publication is Dr. Jiayin Zhang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all patients.

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Institutional Review Board approval was obtained.

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No study subjects or cohorts have been previously reported.

Methodology

  • Prospective

  • Observational study

  • Performed at one institution

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Yuan, J., Ding, X., Yang, W. et al. The impact of lipoprotein(a) level on cardiac pathologies in diabetes: a cardiac CT study. Eur Radiol 35, 220–231 (2025). https://doi.org/10.1007/s00330-024-10903-4

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