Lipoprotein(a), are its levels really invariable?

Background In the studies available today lipoprotein(a), Lp(a), has been described as a genetic determined cardiovascular risk factor that usually stays constant through time and therefore it´s not affected by drug therapy or lifestyle changes. Purpose This study tries to evaluate the presence of changes in Lp(a) levels depending on the moment of extraction (acute event vs ambulatory stable period) seen as now a days there are no clear guidelines about when is the best moment to evaluate this particular cardiovascular risk in our patients. Methods Based on a cohort of 344 patients included in the cardiac rehabilitation program of our hospital in between December 2022 and October 2023. We assessed the changes in Lp(a) levels of the 80 patients, admitted after an acute coronary event, that had a Lp(a) determination upon admission for the primary event and at the first ambulatory visit during cardiac rehabilitation. Results Of the 80 patients that were included in the final analysis 21,3% were women, 57,5% active smokers, 52,5% hypertensive, 22,5% diabetic, 53,8% dyslipidemic, 27,5% suffer from obesity and 11,3% had a previous history of coronary disease. Regarding the primary event that led to referral to cardiac rehabilitation 47,5% suffered an STEMI and 43,75% had more than one coronary artery affected. When analyzing the Lp(a) levels upon admission and during cardiac rehabilitation a statistically significant difference was found regarding the presence of changes (Wilcoxon p = 0,000; Z = -3,896). We observed a median of change of 4,9 with an interquartile range of 51. The minimum change observed was of – 90 nmol/L and the maximum of +206 nmol/L. In the adjacent figure (picture 1) we can appreciate the individual changes in each and every one of the patients included in the analysis. Conclusions Based on the results observed in our sample we can conclude that there is a statistically significant difference between Lp(a) levels upon admission for an acute event and Lp(a) levels during cardiac rehabilitation in the ambulatory setting. However, there is still need for more studies to seek clarification upon the matter of when is the best clinical state/moment to evaluate cardiovascular risk, due to this biomarker, in our secondary prevention patients.