This retrospective study examined whether the association between lipoprotein(a) [Lp(a)] and subclinical coronary atherosclerosis differs between men and women. A total of 7,201 asymptomatic individuals without known coronary artery disease who underwent coronary CT angiography (CCTA) were included and stratified into three groups according to their Lp(a) levels.
Among men, participants in the highest Lp(a) tertile were significantly more likely to have non-calcified coronary plaques and obstructive coronary artery disease, defined as ≥50% coronary stenosis. No significant association was observed with calcified or mixed plaques. In contrast, women with the highest Lp(a) levels showed a significantly higher prevalence of calcified plaques and obstructive coronary artery disease, whereas no significant association was found with mixed or non-calcified plaques.
Overall, elevated Lp(a) levels were associated with more advanced subclinical coronary atherosclerosis in both sexes. However, plaque composition differed between men and women, suggesting that Lp(a) can influence the development and progression of coronary atherosclerosis differently according to sex.