Introduction: Menopause may coincide with rising lipoprotein (a) Lp(a) levels, a pro-atherogenic, pro-thrombotic, and pro-inflammatory atherosclerotic cardiovascular disease (ASCVD) risk factor. Characterizing changes in Lp(a) across menopause may improve risk stratification and inform testing recommendations for women. Hypothesis: Lp(a) levels increase during menopause and these increases are most pronounced in women with intermediate Lp(a) levels. Methods: We examined changes in serum Lp(a) levels by menopausal status among women with Lp(a) measured at visits 1 and 2 in the UK Biobank. Lp(a) was measured via isoform-insensitive immunoturbidimetry, and menopausal status was self-reported. Analyses were stratified by menopausal status: those who underwent menopause (N=415), those who remained premenopausal (N=532), and those who remained postmenopausal (N= 3,615) between visits. The primary outcome of interest was crossing the risk-enhancing threshold of Lp(a) >125 nmol/L between visits. Results: Data were available for 4,562 women (100% European ancestry, mean age at visit 1 = 57±7 years; median Lp(a) at visit 1 = 22 (IQR: 47) nmol/L; median time between visits = 4 (IQR: 1) years; 5% prevalence of hormone therapy use). Median Lp(a) at visit 1 was similar among women who underwent menopause and the premenopausal group (17 nmol/L and 19 nmol/L, respectively) and higher for the postmenopausal group (23 nmol/L). Overall, Lp(a) median changes were modest among women who underwent menopause (3.0 nmol/L, IQR: -0.7, 11.2) and women in the pre- and post-menopausal groups (both 0.7 nmol/L) ( Table ). However, among women with intermediate visit 1 Lp(a) levels (75-125 nmol/L), the median change between visits increased to 34.9 nmol/L (-6.7, 53.0) for women who underwent menopause. These changes were on average 26 nmol/L larger than changes estimated for women in the pre- and post-menopausal groups. Further, 56% of women with intermediate visit 1 Lp(a) levels who transitioned through menopause during the study exceeded 125 nmol/L by visit 2, compared with 29% and 28% of women who remained pre- or post-menopausal. Conclusion: Relying on a single lifetime Lp(a) measurement may miss clinically relevant increases during menopause. Repeat testing in women as they age may improve identification of those at high risk for ASCVD.
Palmer et al. (Tue,) studied this question.