Variability of lipoprotein(a) levels in patients hospitalized in an emergency setting

Introduction Lipoprotein(a) [Lp(a)] is a highly atherogenic lipoprotein with a well-established role in atherosclerotic and thrombotic disease. Its circulating concentration is considered predominantly genetically determined and relatively stable across the lifespan. However, emerging evidence suggests that Lp(a) levels may fluctuate to a greater extent than previously assumed, particularly in the context of acute illness. Understanding this variability is essential, as Lp(a) is increasingly recognized as a priority biomarker in preventive cardiology. Purpose To assess short-term variability in Lp(a) concentrations among patients hospitalized in an emergency setting. Methods The study prospectively included patients admitted urgently to the hospital who had Lp(a) measurements perfrmed at least 3 times during hospitalization every 2 days. Clinical history and relevant laboratory parameters collected at the time of each Lp(a) measurement were analyzed. Results A total of 60 patients (37 women and 23 men) were included, with a median age of 81.0 years (IQR: 70.5–88.5). The most common comorbidities were hypertension (n = 42), chronic kidney disease (n = 24), diabetes mellitus (n = 23), and a history of myocardial infarction and/or stroke (n = 14). Mean lipid levels were as follows: total cholesterol 3.5 (IQR: 2.6 - 4.2) mmol/L, HDL cholesterol 0.9 (0.5 - 1.2) mmol/L, LDL cholesterol 1.8 (IQR: 1.4–2.8) mmol/L. A significant increase in Lp(a) concentration was observed between the first and third measurements (p = 0.017) (Figure 1). The absolute difference between the medians of maximum and minimum Lp(a) values during hospitalization was 9.1 (IQR: 3.7–26.2) nmol/L, corresponding to a relative change of 37.3% (17.8–88.1) (p < 0.001). In the subgroup of patients who underwent four Lp(a) measurements (n = 31), the absolute difference was 14.5 (5.4–37.4) nmol/L and the relative difference was 34.5% (17.8–73.8) (p < 0.001). Conclusions In patients admitted in an emergency setting, Lp(a) concentrations show marked short-term variability. These findings indicate that a single Lp(a) measurement obtained shortly after emergency admission may not reliably reflect true cardiovascular risk. For preventive cardiology practice, Lp(a) assessment should therefore be interpreted cautiously.