Cynthia Jackson

👉Association of Lp(a) With Coronary Atherosclerosis and CV Events 🤔 Lp(a): perhaps more atherogenic than thrombogenic? 1️⃣ What does SCAPIS cohort tell us? In >28,000 individuals followed for 7.8 years, high Lp(a) was associated with: → More coronary atherosclerosis → Earlier development of plaque → More obstructive disease → ~50% higher risk of coronary events 👆 But here is the key: At a similar plaque burden, high Lp(a) was NOT associated with more events. Mediation analysis suggested that most of the excess risk associated with Lp(a) was explained by greater atherosclerotic burden, with no significant direct effect on events. 2️⃣ Could this help us think about the negative Lp(a)HORIZON trial? Perhaps. If the major clinical effect of Lp(a) is to accelerate atherosclerosis over decades, rather than primarily triggering thrombosis on established plaques, then: Lowering Lp(a) late in the disease course may not rapidly reverse decades of accumulated plaque burden. This does NOT rule out prothrombotic or plaque-vulnerability effects. But it raises an important question after HORIZON: With Lp(a), could timing matter as much as lowering? 🔓🔗 doi.org/10.1016/j.jcmg.2026.… @society_eas @JACCJournals Congrats @EliasBjornson and co-authors