High coronary artery calcium score increases risk of heart attack or stroke

Parag Joshi

Patients with both a high lipoprotein(a) and high coronary artery calcium score (CAC) face a more than 20% risk of heart attack or stroke over the following 10 years, according to findings from a multicentre study published in the Journal of the American College of Cardiology (JACC).

“We are hopeful that by making the connection between Lp(a) and CAC as dual risk drivers, we can raise awareness in the medical community and improve earlier heart attack prevention for these patients,” said cardiologist Parag Joshi (Texas Southwestern Medical Center, Dallas, USA) author of the study. “Our data may also expedite the development of treatments designed specifically for this high-risk population.”

The study team found that participants with combined high Lp(a) and high CAC had a 22% 10-year risk of heart attack or stroke, compared with a 10‒15% 10-year risk in patients who had either risk factor alone.

Investigators identified three distinct risk-related trends:

High Lp(a), high CAC: These individuals face the highest 10-year risk of heart attack or stroke.

High Lp(a), zero CAC: 10-year heart attack and stroke risk is low when there is no CAC, even if Lp(a) is high.

Low Lp(a), high CAC: 10-year heart attack or stroke risk is higher than average but lower than with high LP(a) and high CAC combined.

“Establishing the connection between Lp(a) and CAC means we can move to the important next phase of research, which will be defining and personalising early screening protocols to identify patients at high risk of heart attack,” said Joshi. “With further research, this could mean selectively scanning patients with high Lp(a) for their CAC score, and studying therapies specifically designed to reduce Lp(a) among patients with high CAC.”

Cardiology researchers confirmed the Lp(a) and CAC connection by comparing data from the Dallas Heart Study and the Multi-Ethnic Study of Atherosclerosis (MESA).


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