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. 2025 Oct 18:zwaf680.
doi: 10.1093/eurjpc/zwaf680. Online ahead of print.

The Role of Lipoprotein(a) in Predicting Coronary Artery Disease Among Ageing Endurance Athletes and Healthy Controls

Rik Pauwels  1   2   3   4 , Ruben De Bosscher  3   4 , Jarne De Paepe  1   2   3   4 , Christophe Dausin  5 , Youri Bekhuis  1   2   3   4 , Boris Delpire  1   2   3   4 , Peter Sinnaeve  3   4 , Steven Dymarkowski  6 , Olivier Ghekiere  2   7 , Jan Verwerft  1   2 , Tatiana Kuznetsova  3 , Liesbeth Bruckers  8 , Caroline M Van De Heyning  9   10 , Paul L Van Herck  9   10 , Lieven Herbots  1 , Tomas Robyns  3   4 , André La Gerche  11   12   13 , Hein Heidbuchel  9   10 , Rik Willems  3   4 , Guido Claessen  1   2   3 ; Master@Heart Consortium
Collaborators, Affiliations

The Role of Lipoprotein(a) in Predicting Coronary Artery Disease Among Ageing Endurance Athletes and Healthy Controls

Rik Pauwels et al. Eur J Prev Cardiol. .

Abstract

Aims: Ageing endurance athletes have a higher prevalence of coronary artery disease (CAD) on coronary CT angiography (CCTA) than healthy controls, despite similarly low conventional cardiovascular risk. The predictive value of lipoprotein(a) [Lp(a)] for CAD in these low-risk individuals remains unclear.

Methods: The Master@Heart study included 558 men (aged 45-70 years) without known cardiovascular risk factors: 191 lifelong athletes, 191 late-onset athletes, and 176 healthy controls. CCTA assessed coronary artery calcification (CAC) and plaques. The association between Lp(a) and subclinical CAD was assessed using logistic regression analysis to estimate odds ratios (ORs), adjusted for cardiovascular risk factors. Lp(a) was analysed dichotomously (<125 vs. >125 nmol/L) and continuously (per 10 nmol/L increase).

Results: 76 participants (13.6%) had elevated Lp(a) levels (>125 nmol/L). Elevated Lp(a) was significantly associated with age-specific CAC percentile≥75 (OR 1.80, p=0.049) and ≥1 mixed plaque (OR 1.76, p=0.046). Other CAD measures all tended to be more prevalent in those with elevated Lp(a). In the continuous analysis, Lp(a) was significantly associated with CAC>100 (OR 1.03, p=0.045), CAC percentile≥75 (OR 1.04, p=0.014), and ≥1 mixed or non-calcified plaque (OR 1.03, p=0.029).Lp(a) and prevalence of elevated Lp(a) were similar across lifelong athletes, late-onset athletes, and controls (p=0.586 and p=0.724, respectively). No significant interaction was found between Lp(a) and the exercise groups in predicting CAD.

Conclusions: Lp(a) is independently associated with subclinical CAD in ageing endurance athletes and healthy controls, despite similarly low conventional cardiovascular risk. Lp(a) does not explain the higher CAD prevalence in lifelong athletes compared to controls, but may enhance risk stratification in this low-risk population.

Keywords: Ageing endurance athletes; Cardiovascular risk stratification; Coronary artery disease; Coronary computed tomography angiography; Lipoprotein(a).

Plain language summary

Elevated lipoprotein(a) [Lp(a)] levels, both at the clinically relevant threshold (>125 nmol/L) and measured continuously, are linked to coronary atherosclerosis on CT imaging in both ageing endurance athletes and healthy controls, even when they have no traditional cardiovascular risk factors. Elevated Lp(a) (>125 nmol/L) was independently associated with increased coronary artery calcification and the presence of at least one mixed coronary plaque.Lp(a) may help identify hidden coronary atherosclerosis in low-risk individuals and support more personalised cardiovascular assessments.

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