LPA and atherosclerosis: Several mechanisms could play a role in differential impact of Lp(a) between patients with versus without DM as following: first, individuals with DM are more likely to coronary atherosclerosis, even in the absence of prior ASCVD events, Thus, it is plausible that elevated Lp(a) may demonstrate a higher propensity for atherothrombotic events once coronary artery disease (CAD) is established.