Longitudinal patterns and determinants of lipoprotein(a) variability: a 15-year multi-center study

Lipoprotein(a) [Lp(a)] concentrations are mainly determined by genetic factors, yet evidence on their long-term variability and determinants remains limited, particularly among Asian populations. This study examined temporal changes in Lp(a) concentrations and identified clinical predictors of substantial intra-individual elevation. We conducted a retrospective cohort study using the Chang Gung Research Database from January 2004 through December 2019. Adults with baseline and follow-up Lp(a) measurements at least one year apart were included. Participants were categorized according to temporal changes: increase ≥ 10 mg/dL, increase < 10 mg/dL, or decrease. Multivariable logistic regression was used to identify predictors of Lp(a) increase ≥ 10 mg/dL. Among 17,363 participants (mean age 42.1 years; 73.3% male) with a mean follow-up of 5.2 years, median Lp(a) levels declined from 9.3 mg/dL (interquartile range [IQR] 4.1–17.3) to 7.4 mg/dL (IQR 3.6–16.3). Only 479 participants (2.8%) exhibited an increase of ≥ 10 mg/dL. Independent predictors of such elevation included higher baseline Lp(a), new statin initiation, diabetes mellitus, female sex, and higher triglyceride levels. In this large longitudinal Taiwanese cohort, Lp(a) concentrations were generally stable, with only a small proportion showing substantial increases. However, specific clinical factors predicted Lp(a) elevation, suggesting that repeat Lp(a) measurements may be warranted in selected high-risk individuals to enhance cardiovascular risk stratification. Not applicable.