Our study demonstrated that combination of a reduced LMR and Lp(a) ≥ 30 mg/dL is associated with the progression of carotid atherosclerosis with an OR of 4.3 (1.1–17.2), p = 0.04, but this is not the case for the patients with normal Lp(a) levels and an LMR above the median. This evidence concerns the gene LPA and carotid atherosclerosis.